Subrecipient Commitment Form

This form is owned by Boise State University, Office of Sponsored Programs, 1910 University Drive, Boise, ID 83725-1135 USA. Questions about this form should be directed to preaward@boisestate.edu

GDPR/PIPL/PRIVACY NOTICE

Please review Boise State University’s Privacy Statement .

Boise State University Proposal Number(Required)

Note: If you do not have this number, please request it via email to preaward@boisestate.edu.

SECTION I: INSTITUTIONAL INFORMATION

Note: All fields with an asterisk (*) next to them are required and must be completed.

Full Legal Name(Required)

For U.S. institutions, this is the full legal name shown on the Secretary of State’s website where the institution was organized or incorporated. Example: Foundation Research Holdings, LLC (i.e., Delaware Secretary of State website).

Is Subrecipient an FDP Expanded Clearinghouse Member?(Required)

See https://fdpclearinghouse.org/

Yes

Is Subrecipient Listed on the FDP FCOI Institutional Clearinghouse?(Required)

See https://thefdp.org/default/fcoi-clearinghouse/compliant-entities/

Yes

Is Subrecipient Organized or Incorporated in the USA?(Required)

Yes

U.S. State of Organization or Incorporation(Required)

U.S. Congressional District (e.g., ID-002)(Required)

Country of Organization or Incorporation(Required)

Entity Type(Required)

Institution of Higher Education (Governed by a State, Province or Other Governmental Entity)

Non-Profit Entity

For-Profit Entity

Governmental Entity

Other

Institution Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code + 4 Country

U.S. Federal Employer ID Number (EIN)(Required)

Type “N/A” if this is not applicable to your organization.

Email Address of the Individual Completing this Form(Required)

Enter Email Confirm Email

Is the Proposal Submission Contact the Individual Completing this Form?(Required)

Yes

Email Address of Proposal Submission Contact(Required)

Enter Email Confirm Email

Proposal Submission Contact Phone Number(Required)

Make sure to add the country code if located outside of the United States.

Email Address of the Person to Whom the Subaward/Subcontract Should be Sent.(Required)

This is the person to whom Boise State University should send the Subaward or Subcontract for review by the Subrecipient.

SECTION II: GENERAL PROJECT INFORMATION

Will this Project Use Federal or Federal Flow-Through Funds?(Required)

Yes

Is Subrecipient Currently Registered in the System for Award Management (SAM)?(Required)

See https://sam.gov/content/home

Yes

SAM registration is a mandatory prerequisite to receiving a Subaward or Subcontract from Boise State University. The SAM registration website is available here.

Unique Entity ID (UEI)(Required)

See https://sam.gov/content/duns-uei

DUNS Number(Required)

Subrecipient Principal Investigator Name(Required)

Prefix First Last

Subrecipient Principal Investigator Title(Required)

Subrecipient Principal Investigator Email Address(Required)

Enter Email Confirm Email

Subrecipient Proposal Title(Required)

Anticipated Subaward Start Date(Required)

yyyy

Anticipated Subaward End Date(Required)

yyyy

Total Funds Requested (USD)(Required)

Is Cost Share Required?(Required)

Yes

Cost Share Amount (USD)(Required)

Statement of Work and Budget(Required)

Identify which documents will be uploaded below. All are generally required to receive a Subaward from Boise State.

Statement of Work (details must separate Subrecipient’s duties from Boise State’s responsibilities)

Detailed Budget (including cost share detail if applicable)

Budget Justification (including cost share detail if applicable)

Does the Budget Include Indirect / F&A Costs?(Required)

Yes

Federal Indirect / F&A Costs Information(Required)

If Subrecipient plans to utilize its Federally negotiated Indirect Cost Rate Agreement, either upload or provide a hyperlink to it below. FDP Expanded Clearinghouse members are exempt from this requirement.

Subrecipient will utilize its Federally negotiated Indirect Cost Rate Agreement.

Subrecipient will utilize a reduced Indirect/F&A rate (i.e., lower than agreed to in its Federally negotiated Indirect Cost Rate Agreement).

Subrecipient does NOT have a Federally negotiated Indirect Cost Rate Agreement and, per 2 CFR 200.414(f), Subrecipient is eligible for and will utilize the 10% MTDC indirect / F&A rate.

SECTION III: RESEARCH COMPLIANCE

Does this project require one or more research compliance protocols?(Required)

Examples: Protocols from Institutional Review Boards (IRB), Institutional Animal Care and Use Committees (IACUC), Institutional Biosafety Committees (IBC) and/or Unmanned Aircraft Systems (UAS) Committees.

Yes

Does this project involve human subjects?(Required)

If “Yes,” exemptions, institutional approval numbers and dates and Federal Wide Assurance Number must be provided before a Subaward is issued.

Yes

Does your organization certify it will follow the National Institutes of Health (NIH) single Institutional Review Board (IRB) plan developed for this project?(Required)

See, e.g., NIH’s Single IRB Policy for Multi-site Research at https://grants.nih.gov/policy/clinical-trials/single-irb-policy-multi-site-research.htm.

Yes

N/A

Does this project involve vertebrate animals?(Required)

If “Yes,” exemptions and institutional approval numbers and dates must be provided before a Subaward is issued.

Yes

Does this project involve Public Health Service (PHS) or National Science Foundation (NSF) funds?(Required)

If “Yes,” all vertebrate animal activities must occur at a PHS-assured institution. Subrecipient’s PHS Assurance Number must be provided before a Subaward is Issued.

Yes

Does this project involve U.S. Department of Agriculture (USDA) funds?(Required)

If “Yes,” all vertebrate animal activities involving USDA covered species must be covered under a USDA registration number, which must be provided before a Subaward is Issued.)

Yes

Does this project involve recombinant or synthetic nucleic acid molecules?(Required)

If “Yes,” exemptions or institutional approval numbers and dates must be provided before a Subaward is issued.

Yes

Does this project involve biohazardous materials?(Required)

If “Yes,” exemptions or institutional approval numbers and dates must be provided before a Subaward is issued.

Yes

Does this project involve Centers for Disease Control (CDC) and/or USDA select agents and/or toxins?(Required)

If “Yes,” exemptions or institutional approval numbers and dates must be provided before a Subaward is issued.

Yes

Does your organization need any assistance with the above research compliance activities?(Required)

Yes

Please contact the Office of Research Compliance for assistance at orc@boisestate.edu.

SECTION IV: CERTIFICATIONS & ASSURANCES

Does this project require Responsible Conduct of Research (RCR) training?(Required)

See, e.g., PHS funding (https://grants.nih.gov/grants/guide/notice-files/NOT-OD-10-019.html); NSF funding (http://www.nsf.gov/bfa/dias/policy/rcr/rcrfaqs.jsp#3).

Yes

Is this project funded by the U.S. Department of Energy's (DOE) Nuclear Energy University Program (NEUP)?(Required)

If “Yes,” Subrecipient may need to implement a Quality Assurance (QA) program or report on the project’s QA elements.

Yes

Will this project involve export controlled material, data or technical assistance?(Required)

See, e.g., Export Administration Regulations (15 C.F.R. Parts 730–774) (EAR), International Traffic in Arms Regulations (22 C.F.R. Parts 120–130) (ITAR), Office of Foreign Assets Control regulations (31 C.F.R. Parts 500–598) (OFAC Regulations), and the Nuclear Regulatory Commission and Department of Energy export control regulations (10 C.F.R. Parts 110 & 810) (NRC/DOE Regulations).

Yes

Explain how this project involves export controlled material, data or technical assistance. Also, provide details about which export control laws and regulations are implicated (e.g., EAR, ITAR, DOE, NRC, OFAC) and whether particular Export Control Classification Numbers (ECCNs) have been identified.(Required)

Subrecipient certifies that it and its principals are not presently debarred, suspended, proposed for debarment or suspension, declared ineligible or voluntarily excluded from participation in any Federal department or agency award.(Required)

If Subrecipient has an active exclusion in the System for Award Management (SAM), it cannot receive a Subaward.

True

False

Subrecipient certifies it has reported, at least semiannually, information about any applicable criminal, civil and/or administrative proceedings in the Federal Awardee Performance and Integrity Information System (FAPIIS) in accordance with Appendix XII to 2 CFR Part 200.(Required)

True

False

Subrecipient certifies it has a Federally compliant Conflict of Interest (COI) policy pursuant to 2 CFR 200.112, 2 CFR 200.318 and/or other applicable statutes, regulations and policies including, without limitation, PHS requirements in Subpart F to 42 CFR Part 50 and 45 CFR Part 94 when applicable.(Required)

If “True,” either upload your policy or provide an active hyperlink below.

True

False

Subrecipient COI Plans.(Required)

Subrecipient requests to follow Boise State’s COI policy. Subrecipient’s use of Boise State’s COI policy requires advance written permission from Boise State. All requests to use Boise State’s COI policy shall be directed to coi@boisestate.edu.

Subrecipient will draft a compliant COI policy and provide it to Boise State. Subrecipient will not be issued a Subaward until Boise State receives a copy of this policy.

SECTION V: RISK ASSESSMENT

Personnel(Required)

Subrecipient’s personnel are highly experienced in the performance of the Statement of Work.

Subrecipient’s personnel are experienced in the performance of the Statement of Work.

Subrecipient’s personnel are inexperienced in the performance of the Statement of Work.

Experience With Similar Subawards or the Awarding Organization(Required)

Subrecipient has prior experience with the same or similar Subawards (or has received awards directly from the awarding organization).

Subrecipient does not have prior experience with the same or similar Subawards.

Subrecipient does not have prior experience with the type of work or programmatic deliverables required by this type of Subaward.

Accounting and Procurement Systems(Required)

Subrecipient has established and compliant accounting and procurement systems.

Subrecipient has new or substantially changed accounting and/or procurement systems.

Adequacy of Facilities(Required)

Subrecipient’s work will occur in an adequate, established space.

Subrecipient’s work will not occur in an adequate, established space.

Single Audit Compliance(Required)

Subrecipient’s required audit is COMPLETE for the most recent fiscal year. The audit report disclosed NO material weaknesses, significant deficiencies, reportable conditions or findings. A complete copy of the audit report is included with this submission.

Subrecipient’s required audit is COMPLETE for the most recent fiscal year. The audit report disclosed material weaknesses, significant deficiencies, reportable conditions or findings. A complete copy of the audit report is included with this submission.

Subrecipient’s required audit is INCOMPLETE for most recent fiscal year. Upon completion, Subrecipient will promptly e-mail a complete copy of the audit report to preaward@boisestate.edu.

Subrecipient is NOT subject to 2 CFR 200.501 because it expended LESS than $750,000 in total Federal funds during the most recent fiscal year or it is a for-profit organization.

Note: Please attach or link to your most recent audited financial statement below. If you require Boise State University to sign a Non-Disclosure Agreement (NDA) to receive this information, please complete the University’s NDA by clicking here. In the footer on page 1 of the NDA, please type “OSP Grants & Contracts Officer, sponsoredagreements@boisestate.edu.”

Page Number(s) for Relevant Material Weaknesses, Significant Deficiencies, and/or Reportable Conditions or Findings(Required)

Email Address of Audit Contact(Required)

Phone Number of Audit Contact(Required)

Make sure to add the country code if located outside of the United States.

SECTION VI: REQUIRED INFORMATION

A number of documents were referenced above (e.g., Statement of Work, Budget, Budget Justification, Indirect Cost Agreement, Conflict of Interest Policy, Single Audit). Please provide all required documents by adding hyperlinks and/or uploading them below.

Hyperlinks to Supporting Documents

Upload Supporting Documents

The following file extensions are permitted: doc, docx, xls, xlsx and pdf. There is a 12 MB limit per file.

Drop files here or

Accepted file types: doc, docx, xls, xlsx, pdf, Max. file size: 10 MB, Max. files: 10.

SECTION VII: SIGNATURE

By signing below, you are certifying and agreeing that: (1) the information and representations above are accurate, complete and have been read, signed and made by an authorized official of the Subrecipient named herein; (2) Subrecipient’s appropriate programmatic and administrative personnel have reviewed and approved the above referenced proposal, are aware of the time, space and resources committed to the project and are prepared to establish the necessary inter-institutional agreement(s); (3) any work begun and/or expenses incurred prior the commencement of the period of performance of a fully signed Subaward (i.e., signed by both Subrecipient and Boise State University) are at Subrecipient’s own risk; and (4) your typed name below shall be deemed to be an original signature for all applicable purposes in accordance with the Uniform Electronic Transactions Act, Idaho Code §§ 28-50-101 et seq., as amended from time to time.

Signature of an Authorized Official of the Subrecipient(Required)

Type your name above as your signature. The signatory here does NOT have to be the Subrecipient’s Authorized Organizational Representative (“AOR”). Instead, the signatory must be an individual authorized to submit this Subrecipient Commitment Form on behalf of the Subrecipient according to the Subrecipient’s own internal procedures.

Prefix First Last

Date Signed(Required)

yyyy

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