This form is supported by the GG S2S Forms Questionnaire; several data items previously mapped to and reported on the retired PHS Checklist have been relocated by the sponsor to this V 2.0 form.
The following Question IDs are mapped to this 2-0 form version (listed in the order they appear on the form, as needed: 2, 3, 121, 5, 6, 7*, 118, 119, 120, 114, 115, 116, & 117. Rules (KC, 145, KC146, KC148,) supports multiple overlapping forms and versions.
KRACOEUS-6668 Grants.gov: new form 'PHS 398 Cover Page Supplement 2-0' Release 5.2 S3
|
|
The 2.0 form supports listing 200 stem cell lines, but this questionnaire/question (id7) is limited to 20 responses (consistent with prior form versions). The ability to support 200 responses will be included in a future release. |
|
# DAT |
Form Location |
KC Tab |
Field |
Instructions | ||||
|
| ||||||||
|
1-00 |
Project Director / Principal Investigator (PD/PI) |
Key Personnel
|
Principal Investigator (NIH: PI/Contact) |
Person data (First name; Last name) of the selected Principal Investigator is published. | ||||
|
| ||||||||
|
02-01 |
Clinical Trial |
Questionnaire
|
Q ID 2 |
Check "yes" or "no" to indicate whether the project is a clinical trial. | ||||
|
02-04 |
Agency-Defined Phase III Clinical Trial? |
Questionnaire
|
ID 3 |
Check "yes" or "no" to indicate whether the project includes an agency-defined phase III clinical trial. See Application Guide for the specific definition. | ||||
|
| ||||||||
|
03-00 |
Disclosure Permission Statement |
Questionnaire
|
Q ID 121 |
If this application does not result in an award, is the Government permitted to disclose the title of your proposed project, and the name, address, telephone number and e-mail address of the official signing for the applicant organization, to organizations that may be interested in contacting you for further information (e.g., possible collaborations, investment)? Select "yes" or "no" to indicate whether disclosure permission is granted. | ||||
|
| ||||||||
|
4 |
Program Income |
Budget: |
Project Income |
Enter Income and Description for each project period where income is expected. If the application is funded, the Notice of Grant Award will provide specific instructions regarding the use of such income. | ||||
|
Refer to the panel level help for full instructions on entering Project Income. Note: this form supports 5 entries detailing Project Income by project period. | ||||||||
|
| ||||||||
|
Human Embryonic Stem Cells |
Questionnaire |
Q ID 5 |
Does the proposed project involve human embryonic stem cells? A Yes response will present additional questions. | |||||
|
Can a Specific Stem Cell line(s) be referenced? |
Questionnaire
|
Q ID 6 |
Can a specific stem cell line be referenced at this time? If stem cells will be used, but a specific line cannot be referenced at the time of application submission, include a statement in your narratives that one from the registry will be used. | |||||
|
List the specific stem cell line(s) |
Questionnaire
|
Q ID 7 |
List the registration number of the specific cell line(s) from the stem cell registry found at: http://stemcells.nih.gov/registry/index.asp | |||||
|
Refer to the NIH Registry website http://grants.nih.gov/stem_cells/registry/current.htmThe maximum allowed length of each registration number is four digits (4). List up to 20 registration numbers of the cell lines in the provided fields. The cell lines MUST match the active, valid cell lines to avoid submission errors at NIH eCommons. | ||||||||
|
| ||||||||
|
| ||||||||
|
6 |
Is this a Renewal application |
Questionnaire
|
Q ID 118 |
Select Yes or No. If Yes, additional questions will be presented. | ||||
|
6a |
Inventions and Patents (reporting information required for Renewal applications) |
Questionnaire
|
Q ID 119 |
Check "No" if no inventions were conceived or reduced to practice during the course of work under this project. Check "Yes" if any inventions were conceived or reduced to practice during the previous period of support | ||||
|
6b |
If "Yes" (inventions were conceived or reduced to practice) |
Questionnaire
|
Q ID 120 |
Answer Yes or No as to whether this information has been reported previously to the PHS or to the applicant organization official responsible for patent matters. | ||||
|
| ||||||||
|
7 |
Change of Investigator |
Questionnaire
|
Q ID 114 |
Does this application reflect a change in principal investigator/program director from that indicated on a previous application? Select Yes or No. | ||||
|
|
If Yes, Select the PI |
Questionnaire
|
Q ID 115 |
Search the Address Book to find the Investigator. | ||||
|
|
Change of Institution |
Questionnaire
|
Q ID 116 |
Has the grantee institution changed with this application?
| ||||
|
|
If Yes, select the Institution |
Questionnaire
|
Q ID 117 |
Search the Rolodex and select the former Institution (the Organization from rolodex record will be used). | ||||
Prior Form Versions:
|
PHS398 Cover Page Supplement (1-0, 1-1, 1-3, 1-4) |
Retired by Sponsor. Similar instructions to current if needed |
1-3 Required YNQ 13: New Investigator: (NIH Beginning Investigator); removed on V 1-4.
1-0, 1-1 Published PI Degrees (3) on this form; degree data (1) is now required on RR Key Person (expanded) 1-2.