SRS INTERIM FUNDING REQUEST FORM

400 Harvey Mitchell Parkway South, Suite 300 College Station, Texas 77845 (TAMU Campus MS 3578) 979-862-6777, 979-862-3250 Fax Interim Funding is provided for allowable costs incurred on, or after the start date of the account prior to receiving a fully signed award. Account No.: ________________ Proposal No.:_______________ Sponsor: ______________________________________________ Principal Investigator: ____________________________________ Department: _________________________________________ Department Business Contact: _____________________________ Phone: _____________________ TAMU Mail Stop: __________ Period of Performance for Interim Funding: _______________________________________________________________________ Award Amount Expected: ______________________________________________________________________________________ Interim Funding Amount Previously Approved & Open (not yet funded by Sponsor): ______________________________________

Budget Category (FAMIS users) Amount

Salaries & Wages __________________

Fringe Benefits __________________

Travel __________________

Supplies __________________

Miscellaneous Other __________________

Other: ________________________________ __________________

Indirect Cost @ _________________________ __________________

Total Funds Requested for this Action: __________________

BACKUP ACCOUNT: ____ Required ____ Not Required (Not required for TAMU for $20,000 or less) IF THE ANTICIPATED AWARD FOR THIS INTERIM FUNDING IS NOT RECEIVED, OR IF EXPENDITURES ARE UNALLOWABLE OR DISALLOWED BY THE SPONSORING AGENCY, I CERTIFY THAT THE EXPENSES INCURRED UNDER THIS INTERIM FUNDING ACTION MAY BE BILLED TO THE BACKUP ACCOUNT. I FURTHER CERTIFY THAT THE FUNDS IN THIS ACCOUNT ARE FROM A NON-SPONSORED SOURCE. Backup Account No: ______________________ Responsible Department: ______________________________________________ Individual Authorized To Sign For Backup Account: __________________________________________________________________ Signature of Authorized Individual: __________________________________________________Date ________________________ APPROVED: _____________________________________ Date_________ _____________________________________ Date_________ Principal Investigator Authorized System Member Representative _____________________________________ Date_________ _____________________________________ Date_________ Department Head Authorized System Member Representative (if required) _____________________________________ Date_________ _____________________________________ Date_________ SRS Project Administrator/Negotiator SRS Director

New I. F.

Continuation I. F.

07/18/2013

INTERIM FUNDING RISK ANALYSIS:

Compliance Approvals Required: ____No ____Yes

Sponsor Compliance Approvals Required: ____No ____Yes

Conflict of Interest: ____No ____Yes

Proposal Submitted: ____No ____Yes

____ Confirmation received from a Grants/Contracting Officer that award will be issued including estimated date of receipt, award number and amount.

____ Successful collaboration with sponsor in the past.

____ Federal flow-through funding, and sponsor has confirmed receipt of award from the prime sponsor. ____ Sponsor is a small business. ____ Award has been received, and it does not contain any clauses that require Principal Investigator or System Member approval prior to signature. The Negotiator’s confidence is high that the document will be successfully completed.

____ Sponsor is a Federal agency, and the funding request/approval has not been received by the Contracting/Grants Officer.

____ Proposal not submitted to sponsor.

____ Foreign sponsor.

____ Federal flow-through funding, and the sponsor has not received the award from the prime sponsor.

____ Federal flow-through funding, and the sponsor must submit the final document to the prime sponsor for approval.

____ Sponsor has outstanding invoices for other work.

____ Other past problems with sponsor.

____ Award has been received, and it contains clauses that require Principal Investigator/System approval prior to signature.

Risk Level = Low (L); Medium (M); High (H)

Prepared By: ________________________________ Date____________ Project Administrator/Negotiator

____ Award has been received by the System Member.

____ Award has been signed by the System Member.

07/18/2013