Forms & Templates
FORMS & TEMPLATES
SPA offers a variety of its forms, templates, and worksheets, in PDF and Excel format. In order to read, print, search, and fill-in PDF forms, you will need a copy of Adobe Acrobat or Adobe Reader.
Forms must be downloaded in order to save them. To do so, right-click the link, click "Save Target As...", then choose the destination on your computer.
- eRA Commons Account Registration Obtain eRA Commons account & affiliate with UTHealth
- Individual Research Conflict of Interest Form
- Multiple PI Leadership Plan
- Other Support Example Template - Must be utilized when responding to any JIT request and when submitting revised other support with annual NIH progress reports.
- Transfer In Information Sheet Complete for incoming faculty and send to firstname.lastname@example.org
- Unobligated Balance Calculation
- Cost Transfer Request Used by departments to transfer expenses onto or off of a sponsored project. (Guidance is provided on the form for backup support.)
- Contract Residual Closeout Form Used to request the closure of grants and contracts when funds vest with UT. (Rename and save the PDF form to your hard drive, complete and forward within your department for approval. Return to PAF when completed.) Clinical Closeout requests should not use this form.
- Gift Card Reimbursement Form Include with the non-po voucher documentation when requesting reimbursement of gift cards purchased.
- Modular Grant Information Use when preparing modular grant budgets.
- Person Months Conversion Chart Use to convert % to person months
- Program Income Setup Request Form
- Relinquishing of Grants Procedures for departments and PAF to follow when a PI relinquishes a project.
- Salary Cap Worksheet (For both NIH & CPRIT) Accompanies PA's with federal grants that are subject to the federal Salary Cap.
- Split Account Request Template Used to add an additional sub-project to a main project.
- SPA does not approve split accounts for just salary of another investigator. Split accounts are done when:
- There are at least two schools, or
- It is multi-PI between two departments, or
- The funding for the second account includes: > 20% salary/effort of the investigator, additional personnel expenses, or non-personnel expenses in addition to the salary.
- Stipend Payments Guidance for departments to use when submitting stipends on a project.
- Subcontractor Tracking Form Used to monitor subcontractor invoices receipt and payment. Departments can optionally use the form.
CLINICAL RESEARCH FINANCE
- Checklist to Expedite Device Study Review A form requested by Memorial Hermann Healthcare System to expedite the review of Device Studies to be conducted at MHHS. This form should be completed and submitted to MHHS as soon as possible.
- CALB Tool Guidance Document This document provides guidance on how to complete the Coverage Analysis/Internal Budget tool. (CAIB tool)
- Clinical Research Charge Document Log
- Clinical Trial Budget Template with Coverage Analysis Grid (CAIB tool) Development of a clinical trial coverage analysis grid and budget. It contains internal price lists and formulas for effort calculations. FOR INTERNAL USE ONLY.
- Contract/ Coverage Analysis/ Proposal Record Workflow Document This workflow document provides an overview of the start -up process in SPA for industry initiated clinical studies.
- Coverage Analysis Fees -Industry Sponsored Studies This sheet provides a breakdown of fees with and without IDC applied.
- Coverage Analysis Fee Memo for Industry Sponsors This memo provides information to provide to Industry Sponsors regarding coverage analysis fees.
- EPIC Tip Sheet- Study Coordinator Guide This tip sheet discusses how to link patients to studies, how to link visit encounters to studies, and how to review charges for research visits in Epic
- EPIC Tip Sheet- Manage Study Record This tip sheet discusses how to manage the study record in Epic
- Harris Health Patient Registration Form
- MHH Patient Registration Form
- Link/Associate Patient to Study in Epic- GIF - This is a short video recording showing a researcher linking a patient to a study in Epic (60 seconds no sound). For detailed guidance on how to link/associate a patient to a study in Epic please refer to “EPIC Tip Sheet- Study Coordinator Guide
- Submit CTA to SPA Checklist This checklist can be used as a guide to help ensure you have completed all of the steps for submitting agreements for new clinical studies to SPA.
- Clinical Study START Proposal Record Budget Checklist This checklist is used by the CRFA team to review the proposal record budget for Clinical studies. This includes the review of the attached internal budget (on the CAIB tool) and the budget data entered into the START budget tab. This can be used as a guide to help ensure you have completed all of the needed data for submitting START Proposal records to SPA for new applicable clinical studies.
- Clinical Trial Budget Template with Coverage Analysis Grid Development of a clinical trial coverage analysis grid and budget. It contains internal price lists and formulas for effort calculations. FOR INTERNAL USE ONLY.
- Complex Detailed Budget and Directions Assist in the development of internal budgets for proposals. Use this template for large proposals with numerous personnel and expense lines, such as program projects.
- Set-Up Budget Worksheet for Subcontracts Required for all non-cash basis award set-ups, including cost reimbursable, fee-for-service, and milestone payment accounts with subcontracts.
- Set-up Budget Worksheet and Directions Required for all non-cash basis award set-ups, including cost reimbursable, fee-for-service, and milestone payment accounts.
- Simple Detailed Budget and Directions Assist in the development of internal budgets for proposals. Use this template for standard proposals.
- ECC Access Request Form Gain access to ECC, effort reporting system
- Funding History Access Request Form (email email@example.com for access)
- Effort Minimum Waiver Request a waiver to minimum effort requirements/policy (DocuSign)
- Effort Maximum Waiver Request a waiver to maximum effort requirements/policy (DocuSign)
- Effort Commitment Template Effort Commitment Excel form
- Person Months Conversion Chart Use to convert % to person months
SYSTEM ACCESS FORMS
- ECC Access Request Form - Gain access to ECC effort reporting system
- eRA Commons Account Registration - Obtain eRA Commons account & affiliate with UTHealth
- NSF FastLane Account Registration - Instructions to obtain NSF Fastlane account
- Sponsor/Subcontractor Request Form - Request a new UTHealth START sponsor or subcontractor
- Subcontractor Personnel Request Form - Request access for Subcontractor Personnel
- UTHealth START Delegation Form - Users can delegate tasks/To Do Items to other UTHealth employees
- UTHealth START Access Request Form - Gain access to UTHealth START system