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Agency for Integrated Care - Community Care Research Grant

Application Form

Administrative Instructions

1. The Principal Investigator (PI) must be employed on a full time basis by either a Singaporean private or Voluntary Welfare Organisation (VWO) Community Care organisation and must spend at least 75% of their time in Singapore. Community Care organisations include community hospitals, nursing homes (including psychiatric nursing homes), day care (including dementia day care centres) and day rehabilitation centres, home nursing, home medical and home rehabilitation services.

2. Every section and field must be completed. Please indicate “NA” where a particular section or field is not applicable. Any blue text serves as samples. Please replace the text in blue with your own entries.

3. All financial figures should be presented in Singapore dollars (S$).

4. The completed Application Form and Annexe(s), both hardcopy and softcopy, are to be submitted to the Agency for Integrated Care in the following manner:

5. Softcopy Submission

Submit the soft copies of the completed Application Form and Annexe(s) to researchgrant@aic.sg in both of the following formats:

i. Microsoft Word format: Editable version of the documents without signatures; and

ii. Adobe PDF format: Colour scanned copies of the documents with signatures

with the subject title: CCRG Application – <Acronym for Host Institution>, <Running Title>(e.g. CCRG Application – AIC, Developing Prediction Models for Disability Outcomes)

6. Hardcopy Submission

Mail the original hard copy of the completed Application Form and Annexe(s) to :

Agency for Integrated Care Pte LtdResearch and Development Office (RDO)5 Maxwell Road, #10-00, Tower BlockMND Complex, Singapore 069111Attn: Community Care Research Grant Secretariat

7. Through the act of submitting this application, the applicant acknowledges that the information may be used or disclosed by Agency for Integrated Care Pte Ltd (AIC) for evaluation, reference and reporting purposes. All information submitted will be

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treated in confidence.

Section 1 – Project information

1. 1 Basic Project Information

Full Proposal TitlePlease limit to 300 characters

Running TitlePlease limit to 50 characters

Host Institution

1.2 Funding Details

Budget Requested ($)

Duration of Support (months)

Section 2 – Project Team

2.1 Project Team Members

Please provide a complete list of the members of the research team including the PI, co-investigators, collaborators, mentor (if any) and other support staff (e.g. research fellows, assistants and PhD students). Describe the roles and contribution of the Co-I and collaborators in achieving the research objectives.

Member Name, &

Project Role

Title or Position, Department, &Institution or Organization

Proportion of member’s FTE

allocated to this project

Number of concurrent

projects, including this

one

Role in this project

Ms Jane Wu, Principal Investigator

Principal Physiotherapist, Singapore Community Hospital

50% 1 Literature review, academic input into research design, compliance with institutional regulation

Mr John Lim Co-Investigator

Research Fellow, Dept of Science and Tech, University of Science and Tech

30% 3 Planning, literature review, research design, participant recruitment, writing up the research project

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2.2 Profiles of Team Members

Please complete the table below for each research team member. Please create additional tables as needed.

Full Name

Title (Miss, Mrs, Ms, Mr, Dr)

Office Mailing Address

Email Address

Phone Number

Fax Number (if applicable)

Current position (Please provide full details, i.e. primary, joint and other appointments, academic or professional, where applicable.):

Academic qualifications (Please indicate name of degree, institution’s name, and year in which degree was awarded.):

Publications in the past 5 years, if any (Please include only publications of direct relevance to project. State impact factors where available.):

Patents filed, if any (Please include patents both related & unrelated to the proposed project.):

Academic and/ or professional awards, if any:

Research outcomes from other grants, if any (e.g. publications, patents, awards):

Section 3 – Project Description

3.1 Structured Abstract

Please summarize your research project in no more than 300 words. Essential elements of the structured abstract are as follows: Background, Aim, Method, and Impact.

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3.2 Background

Briefly describe the background and the importance of the research, providing relevant references where applicable.

3.3 Specific Aims and Objectives

Please state concisely and realistically what the project intends to accomplish; and what hypothesis (or hypotheses) will be tested, if applicable.

3.4 Methods

Describe the following in detail:a) Experimental design, research protocol (including inclusion and exclusion criteria), subject

research visits (frequency and duration of procedures involved), period of recruitment to accomplish the aims of the research, if applicable.

b) Statistical justification (i.e. sample size calculation), if applicable.

c) Statistical analysis plan or qualitative data analysis plan (i.e. the means by which the data will be analysed and interpreted).

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d) If applicable, novel methodology used and its advantage(s) over existing methodologies.

e) The potential difficulties and limitations of the proposed protocol and alternative approaches to achieve the research aims.

f) Any procedures, situations or materials that may be hazardous to personnel and the precautions to be exercised.

Section 4 – Performance Indicators

4.1 Qualitative Indicator: Impact

Please describe the potential impact of your research findings in the following areas. For indicators which are not applicable, please state “NA”.

a) Solving the Problem Identified.

b) Developing new, generalizable knowledge (e.g. understanding risk factors, developing prediction models for specific disease/disability outcomes, understanding the natural history of a disease, evaluating novel interventions that could prevent/treat diseases).

c) Developing a novel clinical application.

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d) Others, please specify.

4.2 Quantitative Indicators

Please indicate the expected targets for each indicator. For indicators which are not applicable, please state “NA”.

a) Training & Manpower Development in Research for the Community Care sector (inclusive of members of the project team, research assistant to be recruited etc)

Target Indicator Specify Discipline(s) Numerical Value

Healthcare Professionals Occupational Therapy, Physiotherapy

2, 1

Research Assistants Sociology 1

Students

b) Developing Research & Development Networks

Target Indicator Specify Programme(s) Numerical Value

Joint Programmes or Projects with Local Institutes of Higher Learning or Research Organisations

Joint Programmes or Projects with International Institutes of Higher Learning or Research Organisations

c) Disseminating Knowledge & Gaining Recognition

Target Indicator Numerical Value

Poster or Oral Presentation at a Local Conference

Poster or Oral Presentation at an International Conference

Publication in a Peer Reviewed Journal

Publication as Non-peer Reviewed Report

4.3 Additional Indicators

If you would like to propose any additional indicators not found in the sections above, please do so in this section. These indicators may be either qualitative or quantitative. State ‘NA’ if not applicable.

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Section 5 – Project Milestones and Programme Plan

5.1 Milestones

Please complete the table below with the proposed milestones for the project. State activities to be undertaken and the corresponding milestones on a 3-monthly basis. Do create or delete rows as needed.

S/N Period Activities Milestones

1 Month 1 to 3 Preparation of IRB documents and submission of application for review

IRB approval obtained

2 Month 4 to 6

3 Month 7 to 9

4 Month 10 to 12

5 Month 13 to 15

6 Month 16 to 18

5.2 Programme Plan

Please describe, in detail, how you plan to organize the financial and human resources to complete the intended research project. Do include a Gantt chart, as an Annexe, outlining the schedule for all phases of the proposed project.

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Section 6 – Budget

6.1 Breakdown of Requested Budget

Please list the key items and respective costs for each budget category. Do create or delete rows as needed.

1. Manpower Please budget for all the manpower required for the project including part-time personnel and those to be shared with other projects. Note that salaries of the PI, Co-Investigator(s) and collaborators are not fundable. Please use one line for each project team member, including details on whether they are existing personnel in your institution or new staff to be recruited. Provide details on how much time each member will be committing to the project.

Existing or New

(please tick accordingly)

Team Member/ Highest Educational

Qualification Attained

FTE Employment Duration (months)

Annual Salary for 1 FTE

Total Cost

☐ Existing☐ New

Research Assistant / BA Sociology

1 1.5 $50,000 $75,000

☐ Existing☐ New

Subtotal for Manpower

6.2 Equipment Please budget for the equipment you need to purchase to carry out the project. Please provide copies of quotes as an Annexe.

Item Quantity Unit Cost Total Cost

Subtotal for Equipment

6.3 Other Operating Expenses (OOE)This category covers other expenses directly related to the project such as research insurance, etc. The Grant also does not fund conference-related fees or travel expenses. Some examples are provided in blue.

Item Quantity Unit Cost Total Cost

Payments to research participants

IRB Review

Research Insurance

CITI Certification

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Subtotal for OOE

Grand Total

6.2 Justification of Expenses

Please provide justifications for the above manpower (i.e. labour allocation to the proposed technical milestones), equipment (i.e. what equipment and supplies are required, and why existing infrastructure is unsuitable or unavailable where new purchases are proposed) and for each item under OOE described above.

a) Manpower

b) Equipment

c) OOE

Section 7 – Information on Previous and Ongoing Funding

7.1 Previous Applications for AIC Research Grant

Please list all the previous applications for the AIC’s Community Care Research Grant and whether they are completed, ongoing or terminated. Indicate “NA” if this is the first time you are applying for the Community Care Research Grant.

Project Status Approved Funding ($)

Balance Amount ($)

Grant Duration

Grant End Date

Effect of XX on YY Ongoing $50,000 $20,000 1.5 year 31 Jan 2019

7.2 Projects Ongoing or Under Evaluation for Non-AIC Research Grant

Please list all the grants/sources of research funding, which you are planning or are currently in the midst of applying for. Provide details of the source, quantum obtained or applied for, and the components of the research to be covered by the quantum. Indicate the capacity in which the application was filed (e.g. PI, co-investigator, or collaborator). Indicate “NA” if you are not planning or currently in the midst of applying for non-AIC Research Grant.

Project Funding Agency

Funding Applied for

($)

Grant Duration

Application ID

Status

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Section 8 – Institutional Review Board Approval and Research Institution Status

8.1 Institutional Review Board Approval

1. Has this research protocol been submitted for Institutional Review Board review?

☐☐

YesNo

2. If yes, what is the outcome? ☐☐☐☐

ApprovedPending amendmentsRejectedNot applicable

8.2 Research Institution Status

1. Is your organization a Research Institution (RI)?

☐☐

YesNo

2. If no, please indicate how you intend to satisfy the Human Biomedical Research Act research supervision requirement.

☐ Through my mentor’s organization that is an established RI

☐ Through an alternative arrangement (no mentor) with an established RI

☐ Others:________________________

Section 9 – Declaration and Signatures

9.1 Undertaking by Principal Investigator and Co- Investigator(s)

In signing the Grant Application, the Principal Investigator and all Co-Investigators undertake on any Grant Award, to:

Not send similar versions or part(s) of this proposal to other agencies for funding. Submit supporting documents of ethics approval obtained from the relevant Institutional

Review Board for studies involving human subjects. Be actively engaged in the execution of the research and comply with all laws, rules and

regulations pertaining to Human Biomedical Research Act including the Singapore Good Clinical Practice guidelines and the Personal Data Protection Act.

Ensure that AIC’s funding is acknowledged in all publications. Ensure that all publications arising from research wholly or partly funded by AIC will be

forwarded to AIC.

Principal Investigator

Name: Signature:

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Designation:

Institution:

Date:

Co-Investigator (Create or remove table where applicable)

Name: Signature:

Designation:

Institution:

Date:

9.2 Undertaking by the Host Institution

In signing the Grant Application, the Host Institution undertakes, on any Grant Award, to: Provide appropriate support during the grant period. Ensure that the funds provided are used for the appropriate purposes. Ensure that the research project complies with all laws, rules and regulations pertaining to

animal and human ethics, including the Singapore Good Clinical Practice guidelines and the Human Biomedical Research Act.

Have in place a code of practice for research integrity and procedures to deal with unethical research practices.

Chief Executive Officer (or equivalent) of the Host Institution

Name: Signature:

Designation:

Institution:

Date:

If the Principal Investigator is the Chief Executive Officer (or equivalent) of the Host Institution, undertaking by the Chief Executive Officer’s (or equivalent) Reporting officer is required. Indicate “NA” if the Chief Executive Officer (or equivalent) is not the Principal Investigator.

Chief Executive Officer’s (or equivalent) Reporting Officer

Name: Signature:

Designation:

Institution:

Date:

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