OKLAHOMA STATE UNIVERSITY Routing Sheet

Date

Requires Official Signature

Requires Notarization

Requires Other Signature

# to be signed

DATE NEEDED BY

WhoRouting Action

Part 1

Source of Funding

Flow-Thru Funding Source

Primary Routing #

Other Routing #'s

COA/FC # Project # CFDA #

Amount Requested

Amount Awarded

Project Title

Sponsor Name

Reference #

Begin Date

Part 2 Financial Information (Attach documentation as necessary.)

VPR Cost Share FormWaived F&A Documentation

Cost Share Details/Documentation

If "yes", % allowed:Is recovery of F&A limited:

%Amt & % F&A WAIVED $

%Amt & % F&A RECEIVED $

If "yes", $Is Subcontractor(s) requested:

OSU $Sponsor $Equipment budgeted:

If "yes", $:Other F&A exempt costs:

Are there CAS exceptions:

GRA Tuition:

If "yes", what % Required?COST SHARE:

If "yes", $:Third Party Cost Share:

If "yes", attach required form.VPR Cost Share REQUESTED

TOTAL COST SHARE:

Sponsor Waived F&A:

F&A on Direct Cost Share:

Total Direct Cost Share:

Cost Share FOAPAL # (s):

Part 3 Compliance Information (PI must complete all applicable questions.)

IRB #Expires onYesNo

Expires on

IBC#

Address

Approved

Where

Are space alterations requested?

STTRSBIRNeitherIs this an SBIR/STTR project:

Has Conf. Agreement/NDA been signed? Date Signed:YesPendingNo

Has an MTA been signed?

Do you or will you have foreign nationals involved with your research?

Export Control Review Form AttachedHave EAR/ITAR regs been reviewed?

If "yes", :Does a conflict exist?

Updates/Changes?Financial Conflict of Interest Filed Date:

Certified for NIH

Research Services Received Compliance Received GCFA Received Research Services Completed

Dean and/or Director Date

Department Head Date

Principal Investigator Date

Vice President for Research Date

Director of GCFA Date

Research Compliance Date

Org. CodeAddressPI's Department/School

Approvals: Signatures acknowledge that the actions requested on this form and any attachments are consistent with department/division/university policy & objectives, and that all parties' commitments to the project are noted and approved. Principal Investigator/Co-PIs acknowledge all compliance requirements have been met.

YesNo

Prepared by: PH #

Part 4

Part 5

International travel

OutInNoneIs there confidential information: Both

Rm#Amount $:

Pending OR Resolved

YesNo

(Required for RS routings.)

Banner ID

Version 3.0 (7-19)

Research Type: Applied Basic Developmental Reset/NA

Involves CLASSIFIED information (If yes, Facility Security Officer should be contacted.)

Does sponsor reference FISMA or FISMA-like language or CUI?

Will this project need resources from the HPCC?

YesNo

Human Subjects

Animal Use IACUC#

Expires onRecombinant DNANo Yes

No Yes

No Yes

No Yes

IBC#

Infectious Agents, Toxins, Prions Expires on

Radioactive Materials/ X-ray DevicesLaser Safety Inspection (Class 3b & 4)

Space is available for this project:

Appl#

YesNo

Approved

YesNo

YesNo

YesNo

YesNo

YesNo

YesNo If "yes", where:

YesNo

Date Signed:YesPendingNo

Comments & Special Information: Provide any relevant details to help explain reason for routing action. Specify such things as budget changes, no cost extension, change in personnel. Provide split budget information, if applicable.

NIH FCOI Training Date:

End Date