Forms and Documents

General UVA and SOM forms

Volunteer in research form (SOM) Non-research activities occurring in the Medical Center require
approval from the Medical Center Finance Office
Emergency response sheet (ver. 2016; print and post in your area)
Approval of External Activities Form (SOM: required before initiating external consulting)
Request for Extension of Employment of a Postdoctoral Research Associate (UVA)
Faculty departure checklist (Provost’s office)
Staff offboarding site (UVA HR; includes offboarding checklist)
Environmental Health and Safety laboratory close-out checklists:
Chemical and general laboratory close-out (for non-retiring faculty)
Chemical and general laboratory close-out (for retiring faculty)
BSL2 laboratory close-out
Equipment inventory change request (Form P-1; to transfer UVA equipment to another institution)
Request for recognition of a training program (requires UVA log-in)
SOM overview of safety issues associated with research areas
SOM Environmental Health and Safety checklist for laboratories
Gene Transfer SAE Reporting Form
HIC-IBC Application Form

UVA internal funding programs

Bridge/interim support (review both the VPR description of the program and SOM requirements)
SOM Research and Development Grants Program – application form

Institutional documents for proposals to external sponsors

Information for applicants
Office of Grants and Contracts deadline policy
NIH 2016 Common Deadlines
Federal rate agreement (click on “Rates” at the top of the page)
IRS tax-exempt 501(c)(3) letter

Institutional grant and contract forms (pre- and post-award)

SOM proposal approval sheet (“Goldenrod” – new July 2016)
Time release form (for use when routing proposals)
SOM proposal checklist
SP23 form (preliminary account request, grant/contract change request)
At-risk subcontract checklist request (Required with SP23s for at-risk subcontracts)
SP30 (subcontract request form)
Financial Conflict of Interest (FCOI) Information Sheet
SOM external entity Financial Conflict of Interest Certification (required for subcontractors that are not listed at this site).  A printout of the applicable page is needed for your sub site[s].
Sole source justification
Check deposit form
Consortium pre-award checklist
Consortium agreement [UVA – Applicant institution]
Consortium agreement [UVA – Subrecipient institution]
CAS exception request form
Residual account request form

External financial interests/conflict of interest, consulting

Approval of Outside Activities Form (for consulting and related activities)
Guidelines for Option 1 Consulting Agreements
Request for exemption of conflict of interest for research activities (UVA COI Committee; NEW July 2016)
Request for waiver of conflict of interest, Virginia state COI statute (waivers under §2.2-3110.A.5 only)
Report of external financial interests – paper version (for non-UVA investigators only)

NIH forms and documents

NIH Guide notice of salary limitation
PHS 398 forms
PHS 2590 forms
PHS 2590 supplemental information (aka “three questions”)
PHS 3734 – Relinquishing Statement
HHS Form 568 – Final invention statement (also available electronically in eRA commons)
NIH closeout instructions
Table of page limits

Training grant- and fellowship-specific documents and forms

Training grant time release form
NIH fellowship stipend levels
NIH site on research training grants and fellowships (general information)
NIH SF 424 forms
PHS 416-5 NRSA Research Fellowship Activation Notice
PHS 416-9 NRSA Continuation
PHS 6031 NRSA  Payback Agreement Form
PHS 6031-1 NRSA Annual Payback Activities Certification Form
Tuition remission for graduate students
Use the eRA Commons xTrain System to submit PHS 2271 (Statement of Appointment) and PHS 416-7 (Termination Notice) forms.

Contract and clinical trial documents

Contracts checklist (for clinical trials, MTAs, NDAs, consortium agreements, etc.)
Confidentiality disclosure (nondisclosure) agreement request form
Drug study questionnaire
Recommended practices for institutional cost recovery on industry sponsored clinical trials

Material transfer agreements (MTAs)

MTA request form for incoming materials
MTA request form for outgoing materials


Additional Forms

Travel grants to Oak Ridge National Laboratory