Form 4040-0001 10 Year Research & Related (Total Fed + Non-Fed

OMB Approval No.:4040-0001
Expiration Date: mm/dd/yyyy

RESEARCH & RELATED BUDGET (TOTAL FED+ NON-FED) - BUDGET PERIOD 1
Enter nan,e of Organization:

* ORGANIZATIONAL DUNS:
• Budget Type:

D Project

D Subaward/Consortium

• Start Date:!._______.

Budget Period: 1

A. Senior/Key Person

* End Date: '-----�
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Additional Senior Koy Persons: '---------------------'

Total Funds requested for all Senior Key Persons in the attached file
Total Senior/Key Person

B. Other Personnel

• Number of
Personnel * Project Role

CJ Post Doctoral Associates
CJGraduate Students

CJ Undergraduate Students
CJ secretarial/Clerical
CJ

Cal.
Acad.
Sum.
Months Months Months

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Total Number Other Personnel

• Req. Salary ($)

• Fringe Ben. ($)

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C. Equipment Description

List Items and dollar amount for each item exceeding $5,000
• Equipment Item

• Federal ($)

• Non· Federal ($)

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Total Other Personnel

Total Salary, Wages and Fringe Benefits

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• Total (Sal & FB)
(Fed+ Non-Fed)($)

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(A+B) '------------'•-----------'

• Federal ($}

Additional Equipment:

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*Non-Federal($)

• Total (Fed+ Non-Fed) ($)

• Non.federal ($)

• Total (Fed + Non-Fed) ($)

Total funds requested for all equipment listed in the attached file
Total Equipment

• Federal ($)

D. Travel

1.

2.

Domestic Travel Costs (Incl. Canada, Mexico, and U.S. Possessions)

Foreign Travel Costs

Total Travel Costs

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According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid
OMB control number for this information collection is 4040-0001. The time required to complete this information collection is estimated to average 1 hour per response,
including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments
concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200
Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

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