Instructions for Completing the Internal Clearance Form

Instructions for completing the Internal Clearance Form

Section 1:

1. Select Proposal Type. If the proposal is a continuation, provide the current award number in the space provided.
2. Select the Agency Type.
3. Select the Project Type.
4. Indicate if a patent can be derived from the proposed project.

Section 2: Agency DeadlineProvide the agency’s deadline and whether it is a postmark, receipt or electronic deadline.
Section 3: Sponsoring Agency InformationProvide all pertinent information on the agency for which you are requesting funding. This may be the originating agency or a pass through agency. A pass through agency is one that receives block funds from an originating agency to fund projects in a particular area of interest or locality. It may also be a prime awardee that, if funded, will subcontract the AGMUS.

Section 4: Originating Agency

The originating agency is the agency that provides the funding. Also, add the program and CFDA number. For example, the U.S. Department of Education gives money to the State Department of Education that, in turn, funds AGMUS.
Section 5: Proposal TitleInclude the descriptive title of your proposal ensuring not to exceed the limitation indicated in the request for proposal or request for application.
Section 6: Principal Investigator
Provide the requested information about the Principal Investigator. If the proposal is being submitted through a department other than the Principal Investigator’s associated department, make sure to note that in the field provided.
Section 7: Co-Investigator
Provide the requested information about the Co-Investigator. If there is more than one Co-I, provide the information for the other(s) using the Form for Additional Co-Investigators, page 3 of the Internal Clearance Form. / Section 8: Proposal Information
Provide responses to questions a through g by checking the appropriate box. If the answer is “Yes” in any item, please include the additional information requested. Institutional definition for conflict of interest is found in Executive Order No. 04-2003 dated, 04-Apr-2003, Vice-presidency for Financial Administration. Item h, the definition for an institutionalization plan, is that plan that your institution will undertake to assume the cost of this project at the end of the funding period, if institutionalization is required by the sponsor.
Section 9: Budget Information

1. Initial Period: The first year of the project, in MM/DD/YY format.
2. Project Period: The entire period of the project, in MM/DD/YY format.
3. Number of years proposed: Self-explanatory.
4. Total Direct Costs: Total Direct Costs for the entire project. Do not include F&A costs.
5. Does the agency allow F&A Costs? Check “Yes” or “No”. If no, a copy of the provision stating that the agency does not allow F&A Costs must be provided along with the proposal. Also provide a copy of the provision when the percentage of F&A is less than the institutional negotiated rate.
6. F&A Rate: The F&A rate for the project must be identified.
7. Total F&A Costs: F&A Costs for the entire project.
8. Cost Sharing: Indicate if there is cost sharing and whether it is mandatory or voluntary, the amount and account number must be specified.
9. Total Costs: sum of the direct and F&A costs.

Signatures:
The Principal Investigator, each Co-Investigator and the Project Director must sign the Internal Clearance Form. In addition, the Supervisor (Dean/Director), Assistant Vice Chancellor of Sponsored Programs and the Chancellor must sign in the space provided.

IMPORTANT NOTICE:Complete a Research Safety Planning and Notification Form, if your project involves any of the following: a lease/agreement for use of off-campus facilities, environmental permits and licenses, insurances, human subjects research, animal subject research, Biohazard/biomedical materials, radioactive materials, lasers, explosives, carcinogens, controlled substances, generation of hazardous waste, other potentially hazardous materials/activities.