Research Programme Full Application (PA213)

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HRC REF ID# / Research Investment Stream (HW, IOACC or RHM)

Research Programme Full Application (PA213)

Applicants are advised to:

1) register the application online by 12 noon on 12 September 2012 to obtain HRC Ref ID#;

2) read the Guidelines for definitions and instructions before completing this form;

3) read the HRC Rules for applicant eligibility criteria and budgetary entitlements;

4) submit the application online by 12 noon on 19 October 2012 and deliver paper copies by 23 October 2012 at 5 pm;

5) ensure that the correct version of this application form is used.

Incomplete or late applications will not be accepted.

Indicate type of computer used to complete this form (X): Windows PC: or, MAC:

Double-click second pageheader, replace “nm/xyz” with your application HRC Ref ID#; replace “NI surname” with your surname. Double-click elsewhere on the form to return to main part of form. Enter the HRC Ref ID# in the box at the top left of this page.

MODULE 1: GENERAL INFORMATION

Research Title(limit to 80 characters and spaces)
Host Organisation
Research Location
Total Research Staff Costs* / Overhead* / Total Research Working Expenses*
Total Cost of Research / From Budget
Commencement Date / Day/Month/2013
Term / Months

*From budget spreadsheet

Named Investigator 1
Title / First name / Middle name(s) / Surname
Email address / Ethnic Identity**
Department
Host Organisation

**Optional

PA213 Application Form ©2012 Health Research Council of New Zealand. All rights reserved. 1

CONFIDENTIAL

HRC Ref ID#: nm/xyzNI: NI Surname

Lay Summary of Research (150-word limit)

Include research objectives, principal methodologies and potential health outcomes or impact.

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List of Named Investigators

Details must be the same as those in the individual CVs in Module 5.

Copy and paste table for additional investigators.

Named Investigator 2
Title / First name / Middle name(s) / Surname
Email address / Ethnic Identity**
Department
Host Organisation
Role in Programme

**Optional

Named Investigator 3
Title / First name / Middle name(s) / Surname
Email address / Ethnic Identity**
Department
Host Organisation
Role in Programme

**Optional

Named Investigator 4
Title / First name / Middle name(s) / Surname
Email address / Ethnic Identity**
Department
Host Organisation
Role in Programme

**Optional

Named Investigator 5
Title / First name / Middle name(s) / Surname
Email address / Ethnic Identity**
Department
Host Organisation
Role in Programme

**Optional

MODULE 2: RESEARCH

Section 2A – Summary of Research Programme

There is a 1-page limit for this section. Use the headings provided.

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Rationale for Research

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Aims

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Research Design and Methods

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Research Impact

Clearly state the anticipated outcomes of the research, particularly its impact with respect to Investment Signal Goal(s). Please note that this must advance one or more of the Investment Signal goals. The Science Assessing Committee will use this response to judge the future impact of the research and will be scoring based on its relevance to the goals and its contribution to increased knowledge, health, social and/or economic gains; importance of potential outcomes; and pathway for knowledge transfer. Please provide an appropriate and realistic summary.

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Section 2B – List of Proposed Research Objectives

List the proposed research objectives or projects within the programme below.

Objective or Project Title
(80 Characters maximum) / Named Investigator
(Surname, Initial)

Section 2C – Description of Proposed Research Programme (15 pages maximum)

1. Describe the list research objectives or projects and how they form a cohesive theme of research (use diagrams as appropriate). For each component, the rationale, design & methods, impact against Investment Signal goals, and research team track record should be covered.

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2. The long-term goals of the research group as they relate to the HRC Research Investment Streams and Signal goals.

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3. The collaborative nature of the research. Collaboration with other research groups, both nationally and internationally, and if appropriate, liaison with health services providers and the health policy development process.

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4. The staffing, management and organisation of the research programme, including administrative mechanisms, resource and financial management.

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5. The training opportunities for young investigators that exist or will be developed within the programme.

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6. The level of support and facilities provided by the host organisation.

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7. The research group’s productivity and likely impact on improving human health.

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8. The group’s policies and practices for the dissemination of research results.

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9. The research group’s policies and general activities with respect to responsiveness to Maori as it relates to health and/or health research.

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MODULE 3: REFERENCES

There is no limit to the number of reference pages. Asterisks are to be placed beside applicants’ publications. Please provide references in full and state full authorship (for example not Smith et al).

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MODULE 4: CONTRACT INFORMATION AND BUDGET

Section 4A-4D

Use the HRC Excel Spreadsheets ‘HRC213budget.xls’ for Sections 4A-4D.

For the hardcopy of the application

Attach a printout of the spreadsheet Sections 4A-4D (Contract Information (Objectives and Milestones), Budget, MOU Budget(s) and FTE Summary) after this page of the application form.

Ensure any page breaks are logically placed to facilitate review.

For the electronic copy of the application

Upload the Excel file when submitting the application Word file to the HRC online submission system (EASY). Note required file name convention.

Section 4E – Justification of Expenses

Justification of Research Staff (as listed in budget)

Justify the role of all staff (named and unnamed). Unnamed postdoctoral fellows should also be justified here. Please note that unnamed PhD students will be disallowed. “Staff” may include research assistants, technicians, medical staff, interviewers, support staff or similar, whose names or position titles are listed in the budget under “Research Staff” and who have specific FTE involvements.

Clearly state if staff will be promoted during the project, or the annual salary inflation will automatically be capped to 3%.

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Justification of Working Expenses and Casual Staff (as listed in budget)

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Section 4F – Previous / Current Contractsand Awards

List Previous / Current Contracts awarded within the past 5 years.

Final HRC end of grant reports may be made available to Science Assessing Committees.

Copy and paste additional tables if required.

Funding agency
Title of research
Investigators
Start date and duration
Total value
Nature of support (1 sentence)
If HRC contract (HRC Ref #), was Final Report filed? If not, why?
Funding agency
Title of research
Investigators
Start date and duration
Total value
Nature of support (1 sentence)
If HRC contract (HRC Ref #), was Final Report filed? If not, why?
Funding agency
Title of research
Investigators
Start date and duration
Total value
Nature of support (1 sentence)
If HRC contract (HRC Ref #), was Final Report filed? If not, why?
Funding agency
Title of research
Investigators
Start date and duration
Total value
Nature of support (1 sentence)
If HRC contract (HRC Ref #), was Final Report filed? If not, why?

Previous HRC Final End of Grant Report(s)

Please upload the pdf version of all previous HRC final end of grant reports (from the Annual Funding Round and Research Partnership Awards) from the past 5 years (for senior Named Investigators) using the online submission system.

Section 5G – Other Support

Other Research Applications Awaiting Decision

Yes / No
Are any named investigators on this programme also named investigators on a project application? (Y/N)
If yes, is the project a component of this programme application such that the Project will be considered withdrawn if the Programme is fully funded?(Y/N). Provide HRC Ref #
If no, then in the area below identify the Project, briefly outline its area of research and clearly explain how your Programme is separate from it.

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Applicants must advise the HRC of the outcome of other research applications through their Research Office.

Copy and paste additional tables if required.

Funding agency
Title of research
Investigators
Start date and duration
Total value
Date of outcome
Areas of overlap with this Application. HRC Ref #?
Funding agency
Title of research
Investigators
Start date and duration
Total value
Date of outcome
Areas of overlap with this Application. HRC Ref #?
Funding agency
Title of research
Investigators
Start date and duration
Total value
Date of outcome
Areas of overlap with this Application. HRC Ref #?

Co-Funding

What other agencies or end-users have been approached or committed to joint or partial funding of this research?

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Financial Interest(s)

Do you or any named investigator have a financial interest related to the research or sponsorship of the research?

Yes / No
Financial interest?

If yes, outline below and provide details of your conflict management strategy.

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Section 4H – Letters of Collaboration/Supporting Documents List

Please list below all memoranda of understanding or sub-contracts, letters of collaboration (which outline material or actual support) and supporting budget documents. Refer to the Guidelines for instructions about how to attach these documents.

Referees and Science Assessing Committee members will see the list below and documents will only be made available on request.

Please note that Appendices are not permitted.

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MODULE 5: NZ MSI STANDARD CV

Please paste the CVs for all staff that will contribute to this research.

Please ensure that all names in CVs are identical to those listed in Module 1 or the application may not be processed.

Ensure that all your publications are listed in full (with full authorship).

MODULE 6: ADMINISTRATION

Do not copy any sections in MODULE 6. Send with original application only.

Section 6A – Ethical and Regulatory Agreement

First Named Investigator
Research Title
Yes / No / Ethics Committee
Requires human ethical approval?
Copy of current human ethical approval attached?
Requires animal ethical approval?
Copy of current animal ethical approval attached?

If this application does not require ethical approval, please briefly provide reason

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If this application requires consent from other regulatory bodies such as ERMA, MAF, DOC, GTAC, SCOTT or Biosafety, please provide reason.

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The following information will be used for administrative purposes.

Yes / No
1. Is the proposed research a clinical trial, a community intervention study or innovative treatment?
2. If yes to the above, do you intend to have an independent Data Monitoring Committee?
3. If yes to the above, will this be through the HRC’s Data Monitoring Core Committee (DMCC)?
If ‘No’ to question 2 or 3 above, please specify.

Note: Information on the structure and operating guidelines of the HRC’s DMCC are available from the HRC website. For further information please contact the Secretary to the DMCC, .

The applicant has read the ‘Guidelines on Ethics in Health Research’ and ‘Te Ara Tika - Guidelines for Maori Research Ethics: A framework for researchers and ethics committee members,’ available from the HRC website and agrees to abide by the principles outlined in them. The undersigned also agrees to provide written evidence before any research procedures commence, that in any study involving animal or human subjects, animal or human materials or personal information, a properly constituted accredited Ethics committee (a list of currently accredited Ethics Committees is available on the HRC website) has examined and agreed to the ethics of the proposal outlined in this proposal. If minor changes in the research design or procedures have been required for ethical reasons, the HRC must be informed of them. The undersigned also undertakes to ensure that all regulatory consents are gained before research commences. For further information regarding the ethical approval process, please contact the Secretary to the HRC Ethics Committee, , or the appropriate accredited Ethics Committee.

First Named Investigator
Name: / Signed: / Date:
Head of Department/School/Faculty or Hospital
Name: / Signed: / Date:

Section 6B – Administrative Agreement

Only one signed copy of this page is required. This form must be returned to the HRC with the original copy of the contract application.

Applications with an incomplete administrative agreement will not be processed.

All HRC applications must include an undertaking to abide by the following administrative agreement:

1.It is understood and agreed that this application and any contract awarded as a result of this application is subject to the Health Research Council of New Zealand Rules (“Permissible Use of Research Funding and Operation of Contracts”). Funds will not be expended for any other purpose than described in this application.

2.The host institution agrees and undertakes to bear all risk and claims connected with any operation covered by this application and to indemnify and hold harmless the Council against any and all liability suits, actions, demands, costs or fees on account of death, injuries to persons or property, or any other losses resulting from or connected with any act or omission performed in the course of the research.

3.The host institution agrees and undertakes to support for the duration of any contract, the work described in this application by making available accommodation, basic facilities for research and the services necessary for its fulfilment.

4.The Head of Department agrees to accept this research within his/her department if a contract is made, agrees to provide workload relief for research staff working on this contract (Principles of Full Cost Funding), and is aware that s/he may be requested by the HRC to provide a confidential assessment of the research during the term of the contract.

5.The host institution official designated below agrees to ensure that the research will have been approved, where necessary, by the appropriate institutional biosafety committee and/or all other required regulatory agencies before research is commenced.

6.The applicant(s) agrees to allow specified personal information to be used for statutory and publicity purposes.

7.The host institution has in place policies and processes to ensure that consultation with Maori has occurred and the application is responsive to the needs and diversity of Maori.

We the undersigned have read the above administrative agreement and undertake to abide by the conditions of this agreement in respect of any contract made by the Health Research Council of New Zealand as a result of this application. We the undersigned confirm that the information provided in this application is to the best of our knowledge true, that all sections are correct at the time of application submission, that each NI agrees to the stated FTE% contribution and that funding to any NI from any source will not exceed 100 FTE%.

First Named Investigator
Name: / Signed: / Date:
Head of Department/School/Faculty or Hospital
Name: / Signed: / Date:
Authorised official on behalf of host institution
Name: / Signed: / Date:
Position: / Host name:

Section 6C – Referees Unacceptable to Applicants

An individual or research group may be unacceptable as referees because: 1) they are direct competitors, 2) there is a conflict of interest, 3) there are commercially sensitivity issues.

Name
Organisation/Location
Reason
Name
Organisation/Location
Reason

MODULE 7: AUSTRALIAN AND NEW ZEALAND STANDARD RESEARCH CLASSIFICATION (ANZSRC)

Section 7A – ANZSRC

This Module is for evaluation purposes only and is mandatory; incomplete applications will not be processed.

Do not copy MODULE 7. Send with original application only.

Applicants are required to categorise their research using the ANZSRC codes for Fields of Research (3) and Socioeconomic Objective (3) classifications found on the HRC weblink ( – find the appropriate 6-digit code(s) and description and insert below. Weighting % entered to nearest 10% and totals to 100%.

Research Descriptors
MSI Fields of Research (FOR) / Weighting (%)
MSI Socioeconomic Objective (SEO) / Weighting (%)
Keywords

Section 7B – Research Mapping Categories

Please indicate with a tick () the category that best describes the starting point of your research (tick one box only):

Gene
Cell biology
Diagnostics
Physiology
Pharmaceuticals/Treatments
Clinical studies
Clinical trials
Health economics
Clinical services
Knowledge Resources
Risk factors
Interventions
At-risk populations
Community services

Check List

Omitting any of these points may result in your proposal being rejected from consideration in this funding round.


Be sure you have used the correct font size and have not exceeded page limits.
Be sure you have used the same name and email address for ALL named investigators listed in Module 1 as what is listed on CVs.
Be sure you have listed the appropriate 6-digit code(s), descriptions and entered weighting to the nearest 10% in Section 7A – Australian and New Zealand Standard Research Classification (ANZSRC).
Check the salary (if applicable) and the administration agreement sections to ensure all relevant signatures and attachments have been obtained.
Submit one double-sided stapled copy with the single-sided bull-clipped signed original.
Be sure that any supporting documents listed in Section 4H are attached as instructed in the Guidelines.

PA213 Application Form ©2012 Health Research Council of New Zealand. All rights reserved. 1

CONFIDENTIAL