UNIVERSITY OF CALIFORNIA, SAN FRANCISCO SUBAWARD REQUEST FORM 

Subaward No. 1. UCSF INFORMATION 2. SUBRECIPIENT INFORMATIONPrime Sponsor Subrecipient Legal Name in DUNS

RAS Award ID RAS Project ID Subrecipient DUNS Subrecipient EIN (9-digit)

UCSF Principal Investigator Subrecipient Principal Investigator

Department Subrecipient Department

Email Email

RMS RSC Contact Information Subrecipient Office of Sponsored Research Contact

Email Email

Departmental Contact for Invoicing Questions Email for Award Documents (if different than above)

Email

Please provide the contact information for the Department Analyst or Program Manager to whom the Subrecipient can direct questions regarding the status of unpaid invoices.

3. NEW SUBAWARDSCurrent Budget Period

to

Budget for Initial Period

$

Total Estimated Period

to

Total Estimated Budget

$ Indirect Cost Rate

% Select one: Federal Rate Per prime sponsor policy De Minimis Rate (10%)

Final Subaward Project Documentation Upload Final Scope of Work (SOW) Upload Final Budget

Working Capital Advance Request

$ Detailed Budget for Advance

Upload Hardship Letter

Upload PI Monitoring Letter

4. AMENDMENT to Subaward #Amendment Actions: To Increase or Decrease Funding complete below:Check all that apply: Budget Dates

No Cost Extension Early Termination Increase/Decrease in Funding $ Updated/Revise Scope of Work Updated Revise Budget

$ Other (see comments in Section 7)

Attach updated or revised subaward documents using the buttons below:

$

A. Increase by this amount

B. Decrease by this amount

C. Carry forward amount

1003 (Rev. 03/2018), 1 of 2

Carryforward will be automatic unless indicated here: Restrict carryforward

New End Date

UCSF Contact for questions about this subaward or the information on this form:

Change in PI:

New Subrecipient PI:

New UCSF PI:

to

Effective Date of Change:

Email:

Phone:

Fixed price - check this box to issue a fixed price subaward:Sponsor approval documentation must be attached, if applicable

Fixed price subaward

NIH Foreign Site Rate (8%)

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DRH 

UNIVERSITY OF CALIFORNIA, SAN FRANCISCOSUBAWARD REQUEST FORM 

5. COMPLIANCE

This Subrecipient is a clinical research recruiting site 

Yes   No

Yes  No 

Subrecipient will be conducting Human Subjects Research under this Subaward 

Subrecipient will be conducting Animal Subjects Research under this Subaward

6. SUBRECIPIENT REPORTING REQUIREMENTS Please indicate the UCSF Principal Investigator's preferred technical reporting schedule. For projects lasting more than 12 months, annual technical reporting is required automatically. Additional finanacial reporting and invoicing requirements may be included under "comments" below.

Technical:     Annual  Semiannual  Quarterly  Milestones & Deliverables Schedule (Include in SOW)

Other (describe in comments) 

7. COMMENTS - Please include any special circumstances or information.

8. PRINCIPAL INVESTIGATOR’S SIGNATURE AND CERTIFICATIONI certify that I understand my responsibilities for monitoring this subaward in accordance with University and agency policies and guidelines.

Principal Investigator Signature  If needed, upload signature page below:

1003 (Rev. 03/2018), 2 of 2

This is a foreign Subrecipient site

For Foreign sites IRB and/or IACUC approval and Sponsor site approval must be attached, if applicable.

For questions about subawards or this form contact CGSubOutTeam@ucsf.edu

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