Form NIST-1263 (REV. 11-2003) [Pages 1 and 2] [Page 3] [Page 4] [Page 5] Click here for details on all forms required for submitting a proposal to ATP.

This form must be completed in its entirety and submitted with each joint venture proposal. The authorized company representative who signs the form must have delegated fiduciary authority. By signing this form, the company representative certifies the commitment of cost sharing, 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 and with all companies/organizations described as joint venture partners about their commitment and cost sharing 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.

1. Enter the competition number as stated in the Federal Register notice.
2. 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.
3. Enter your Dun and Bradstreet (D&B) number. To obtain a D&B number, see http://www.dnbmdd.com/mddi.
4. Enter the duration of the proposed work in years and months. NOTE: The maximum duration allowed for a joint venture is 5 years.
5. 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.) NOTE: The names and information on the other joint venture participants should be identified on Form NIST-1263 (Page 4), Other Joint Venture Participants.
6. 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.
7. 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.
8. Enter the name, telephone number, fax number, and e-mail address of the grant/contract manager at the submitting organization responsible for contract/grant administrative matters. Include the mailing address if it differs from that of the submitting organization.
9. Check all boxes that apply to identify the type of organization.
10. 10.A - 10.C.
1. In each column, enter total amounts requested from ATP for each year, and enter the total in the last column. NOTE: The ATP funding requested must be less than 50 percent of the total project costs.
2. In each column, enter the proposer’s (joint venture’s) total cost sharing for each year, and enter the total in the last column. NOTE: Joint ventures must provide more than 50 percent of each year’s total costs.
3. In each column, enter the total for each year of the project, and enter the entire project total in the last column.
11. Enter the title of the proposal (90-character limit).
12. 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. 13.A. through 13.H. Answer each question by marking an "x" in the appropriate box.
    
    1. Self-explanatory.
    2. If any of the joint venture participants is delinquent on any federal debt, including debt to the Internal Revenue Service, 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.
    3. 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.
    4. 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.
    5. 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).
    6. If any joint venture partner has a parent company outside the United States, identify the parent company or companies and their place of incorporation in item 14. This includes LLCs where the ownership by foreign companies is 50 percent or more.
    7. If any joint venture partner is majority owned by individuals who are not citizens of the United States, explain in item 14.
    8. If any joint venture partner is subject to control by individuals who are not citizens of the United States, explain in item 14.
14. Provide any explanations to answers given in item 13 and any other remarks you wish to offer.
15. Describe why your project needs ATP funding for the industry to form a joint venture or why an existing joint venture requires federal assistance 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.
16. Enter the name and title of the authorized company representative submitting the proposal on behalf of the joint venture.
17. Enter the telephone number of the authorized company representative submitting the proposal on behalf of the joint venture.
18. The authorized company representative submitting the proposal must sign this form.
19. Enter the date the form is signed.

Return to Table of Contents or go to instructions for NIST-1263 Page 3.

Date created: January 24, 2004
Last updated: February 10, 2004