Exhibit
3
INSTRUCTIONS FOR FORM NIST-1262 (Pages 1 & 2):
SINGLE COMPANY ADVANCED TECHNOLOGY PROGRAM PROPOSAL COVER SHEET
This form must
be completed in its entirety and submitted with each single-company proposal.
The authorized company representative who signs the form must have delegated
fiduciary authority. By signing this form, the company representative
certifies the company's commitment to pay all indirect costs and, if included
as additional cost share, any direct costs; verifies the certification
statements on the form; and attests to the accuracy of the proposal. The
signature also signifies that the company representative has coordinated
with top management within his/her own company about their commitment
to the proposed project. Additionally, by signing the form, the company
representative acknowledges that the proposal is being submitted with
the agreement that ATP may use nongovernment reviewers if necessary. (Such
reviewers are screened to eliminate conflicts of interest and are required
to sign nondisclosure agreements.)
Notwithstanding any
other provision of the law, no person is required to respond to, nor shall
any person be subject to, a penalty for failure to comply with a collection
of information subject to the requirements of the Paperwork Reduction
Act, unless that collection of information displays a currently valid
OMB Control Number. The reason for collecting this information is for
NIST to be able to perform the appropriate technical and business reviews
of an ATP proposal. The information obtained will assist in determining
eligibility for federal financial assistance. Responses to the collection
of information are required to be considered for an ATP award. In accordance
with the ATP legislation, information that is obtained by ATP or other
Department of Commerce offices on a confidential basis about business
operations and trade secrets possessed by any company will be protected
by the government and shall be exempt from disclosure under the Freedom
of Information Act.
- Enter the competition
number as stated in the Federal Register notice.
- Enter your employer
identification number (EIN). To obtain an EIN, see http://www.atp.nist.gov/atp/helpful.htm,
or call 1-866-816-2065.
- Enter your Dun
and Bradstreet (D&B) number. To obtain a D&B number, see http://www.dnbmdd.com/mddi.
- Enter the duration
of the proposed work in years and months. NOTE: The maximum duration
allowed for a single company is 3 years.
- Enter the legal
name, street address, city, two letter state abbreviation, ZIP code,
and website of the organization submitting the proposal.
(DO NOT USE A POST OFFICE BOX.)
- Enter the name,
telephone number, fax number, and e-mail address of the Principal Investigator
at the submitting organization who is responsible for the technical
aspects of the proposal. Include the mailing address if it differs from
that of the submitting organization.
- Enter the name,
telephone number, fax number, and e-mail address of the business manager
at the submitting organization who is responsible for business matters.
Include the mailing address if it differs from that of the submitting
organization.
- Enter the name,
telephone number, fax number, and e-mail address of the grant/contract
manager at the submitting organization who is responsible for contract/grant
administrative matters. Include the mailing address if it differs from
that of the submitting organization.
- Check all boxes
that apply to identify the type of organization.
- 10.a - 10.c.
- In each column,
enter the total amount requested from ATP for each year, and enter
the total in the last column. NOTE: The maximum amount of
ATP funding to a single company is $2 million; ATP funds may only
be used to fund direct costs.
- In each column,
enter the proposer’s total cost sharing for each year, and
enter the total in the last column. NOTE: Large companies
must cost share at least 60 percent of the yearly total project
costs (direct plus all of the indirect costs). Small and medium-sized
companies must pay for all of their indirect costs and may elect
to pay part of the direct costs.
- In each column,
enter the total for each year of the project, and enter the entire
project total in the last column.
- Enter the title
of the proposal (90-character limit).
- Enter a NONPROPRIETARY
abstract of the proposed work. As part of the abstract, include a statement
of the technical problem addressed in the proposal. This abstract may
be used as the basis for a publicly distributed abstract should the
proposal be selected for an award.
- 13.A. through 13.H.
Answer each question by marking an “x” in the appropriate
box.
- Self-explanatory.
- If the company
is delinquent on any federal debt, including debt to the Internal
Revenue Service (IRS), provide in item 14 the amount of the debt,
the name of the federal agency to which the debt is owed, how old
the debt is, the circumstances surrounding the establishment of the
debt, and why the debt has not been paid.
- If this proposal
or a similar proposal was submitted to another federal agency, provide
in item 14 the name of the federal agency, the date the proposal was
sent to that federal agency, the name of the financial assistance
program under which the proposal was submitted, the amount of federal
funding requested, and the name and phone number of the agency contact
person.
- If the proposed
R&D involves the use of human subjects, and/or human tissue, and/or
human cell lines, explain in item 14 and indicate whether the research
plan has been reviewed and approved by an Institutional Review Board
(IRB). For further guidance, refer to the ATP Booklet Advanced
Technology Program Guidelines and Documentation Requirements for Research
Involving Human and Animal Subjects, available at: http://www.atp.nist.gov/atp/kit-04/has_guide/contents.htm.
- If the proposed
R&D involves the use of live vertebrate animals, explain in item
14 and indicate whether the research plan has been reviewed and approved
by an Institutional Animal Care and Use Committee (IACUC).
- If a company
has a parent company outside the United States, identify the parent
company and its place of incorporation in item 14. This includes LLCs
where the ownership by foreign companies is 50 percent or more.
- If a company
is majority owned by individuals who are not citizens of the United
States, explain in item 14.
- If a company
is subject to control by individuals who are not citizens of the United
States, explain in item 14.
- Provide any explanations
to answers given in item 13 and any other remarks you wish to offer.
- Describe briefly
why your project needs ATP funding to embark on this project. Why is
private capital not available or not possible? What efforts were made
to secure internal R&D funding as well as external private capital?
Be specific. Providing a general statement indicating the unavailability
of private funding is unacceptable.
- Enter the name
and title of the authorized company representative submitting the proposal.
- Enter the telephone
number of the authorized company representative submitting the proposal.
- The authorized
company representative submitting the proposal must sign this form.
- Enter the date
the form is signed.
Return to Table
of Contents or go to instructions for NIST-1262
Page 3.
Date created: January
24, 2004
Last updated:
February 10, 2004
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