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.

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PRE AWARD

• eRA Commons Account Registration Obtain eRA Commons account & affiliate with UTHealth
• Multiple PI Leadership Plan
• Individual Research Conflict of Interest Form
• Unobligated Balance Calculation

POST AWARD

• 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.
• Cost Transfer Request Used by the departments to transfer expenses. (Do not submit screenshots or payment vouchers as backup support, just General Ledger details and supporting documentation.)
• Cost Transfer/Exception To Policy Request : Form Note Used solely for the use in exception to policy transfers exceeding the 60 day limit as per institutional policy. (Do not submit screenshots or payment vouchers as backup support, just General Ledger details and supporting documentation.)
• Effort Report Calculation Check Ensures each months effort is applied correctly and totals appropriately for each six month reporting period.
• 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

• Clinical Research Billing Procedure Outlines the research billing procedure for clinical studies and establishes the responsible parties for appropriate research billing.
• Call Center "Study Visit Request"
• Case Billing Request Form
• 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.
• Clinical Research Billing Certification Form
• 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.
• General "Study Visit Request"
• Guidance on R&A data entry for CTAs
• Harris Health Patient Registration Form
• MHH Patient Registration Form
• Patient Follow-Up Sheet Use this form as a paper document to give the patient at checkout for scheduling a follow-up research appointment.
• Contract/ Coverage Analysis/ Budget Workflow Document This workflow document provides an overview of the start -up process in SPA  for industry initiated clinical studies.
• Clinical Research Patient Registration /Flagging This document provides instructions on how to  ensure patients are flagged as research participants in billing system  and in medical records.

BUDGET TEMPLATES

• 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. 
• Other Support Example Template - Must be utilized when responding to any JIT request and when submitting revised other support with annual NIH progress reports. 
• 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.

EFFORT

• eCRT Access Request Form Gain access to eCRT, effort reporting system
• Effort Calculation Worksheet Calculate payroll percentages; must be used in conjunction with the HCM Funding History file
• Funding History Access Request Form (email systemsreporting@uth.tmc.edu for access)
• Effort Minimum / Maximum Waiver Request a waiver to minimum & maximum effort requirements/policy
• Effort Report Calculation Check Excel worksheet to allow departments to ensure that each months effort is applied correctly and totals appropriately for each six month reporting period.
• Manual Certification Coversheet Used to manually certify faculty & their support staff, no longer at the university
• Person Months Conversion Chart Use to convert % to person months

SYSTEM ACCESS FORMS

• ecrt® Access Request Form - Gain access to eCRT effort reporting system
• eRA Commons Account Registration - Obtain eRA Commons account & affiliate with UTHealth
• NSF FastLane Account Registration - Instructions to obtain NSF Fastlane account
• REDCap Access Form - Gain access to RedCap 
• 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