New York University A private university in the public service

Office of Sponsored Programs 665 Broadway, Suite 801 New York, NY 10012-2331 Telephone: (212) 998-2121 Fax: (212) 995-4029

PHS (including NIH) COOPERATING INSTITUTION CONSORTIUM STATEMENT

Title of Application:

Prime Grantee Organization:

Sponsor:

Prime Grantee/Principal Investigator:

Sub-Grantee: New York University (NYU)

70 Washington Square South

New York, NY 10012

NYU Lead Investigator:

Phone Number:

Email address:

eRA Commons User Name:

Period of Performance:

Human Subjects Approval Date:

Animal Subjects Approval Date:

Initial Year Entire Project

NYU Direct Costs:

NYU Indirect Costs:

NYU Total Costs:

The appropriate programmatic and administrative personnel of New York University involved in this grant application are aware of the agency’s consortium agreement policy and are prepared to establish the necessary inter-organizational agreement(s) consistent with that policy.

F&A Rate: NYU has an approved rate agreement with DHHS dated 08/20/2013, available at:http://www.nyu.edu/content/dam/nyu/research/documents/OSP/indirectcostrates.pdf

EIN: 1-135562308-A1

Congressional District NY-010

NYU’s registration in the Central Contractor Registration (CCR) is current.

DUNS: 04-196-8306

NYU is exempt from FFATA reporting (i.e., executive compensation) as per OMB guidance.

NYU receives an annual audit in accordance with OMB Circular A-133. Most recent fiscal year report completed is 2012, available on the Federal Audit Clearinghouse. No findings were reported.

Debarment and Suspension: Neither NYU nor its principals: (a) Are presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any Federal department or agency;

(b) Have within a three-year period preceding this application been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

(c) Are presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and (d) Have not within a three-year period preceding this application had one or more public transactions (Federal, State, or local) terminated for cause or default.

Financial Conflict of Interest: NYU has an up–to-date, written, enforced policy on financial conflicts of interest which complies with the provisions of 42 CFR Part 50 (Public Health Service), Subpart F, “Promoting Objectivity in Research”, and will ensure that any Investigator’s significant financial interest found by NYU to be conflicting has been eliminated or managed in accordance with its policy. As subawardee, NYU shall report to the awardee any identified financial conflicts of interest which have not been eliminated. Such report will be made before expenditure of funds authorized under any resulting agreement, and as regards any subsequently identified financial conflicts of interest, within sufficient time for the awardee to meet PHS reporting requirements.

Additional Information:

In order to avoid undue administrative burden on faculty and staff, additional information (beyond that which is required by the prime sponsor for the proposal to be deemed responsive) will be provided to the lead organization at such time an award is to be issued.

For New York University:

Nancy S. Daneau, Director

osp.agency@nyu.edu

NYU Lead Investigator:

_____________________

Signature and Date

____________________

Signature and Date

STATEMENT OF WORK

(Describe the proposed contributions to the specific aims of the project. Identify any particular milestones and/or deliverables and related timelines as appropriate, aside from standard progress reports. Either respond in this text box or attach a file if over 1 page.)

BUDGET & JUSTIFICATION

(Either respond in this text box or attach a file if over 1 page.)