Department of Health and Human Services Public Health Service, Grant Application

Principal Investigator/Program Director (Last, first, middle):

Duesberg, Peter H.

CHECKLIST (Continued
2. PROGRAM INCOME (See instructions, page 32.)
All a No must indicate (Yes or No) whether program income is anticipated during the period(s) for which grant support is requested.
W No [ Yes If "Yes," use the format below to reflect the amount and source(s) of anticipated program income.
et en Anticiated Amount urce s

3.. INDIRECT COSTS
Indicate the applicant organization's most recent indirect cost rate established with the appropriate DHHS Regional Office, or, in the case of forprofit
organizations, the rate established with the appropriate PHS Agency Cost Advisory Office. If the applicant organization is in the process of initially
developing or renegotiating a rate, or has established a rate with another Federal agency, it should, immediately upon notification that an award will be made,
develop a tentative indirect cost rate proposal. This is to be based on its most recently completed fiscal year in accordance with the principles set forth in the
pertinent DHHS Guide for Establishing Indirect Cost Rates, and submitted it to the appropnate DHHS Regional Office or PHS Agency Cost Advisory Office.
Indirect costs will not be paid on foreign grants, construction grants, grants to Federal organizations, and grants to individuals, and usually not on conference
grants. Follow any additional instructions provided for Research Career Development Awards, Institutional National Research Service Awards, and the
specialized grant applications listed on page 6.

DHHS Agreement dated:

06/01/92

No Indirect Costs Requested.

[ DHHS Agreement being negotiated with

- -Regional Office

No DHHS Agreement, but rate established with

Date

CALCULATION*
(The entire grant application, including the Checklist, will be reproduced and provided to peer reviewers as CONFIDENTIAL information. Supplying the
following information on indirect costs is OPTIONAL for forprofit organizations.) See Attached.
a. Initial budget period:

Amount of base

$100,544* x Rate applied

49.5 % = Indirect costs (a)

b. Entire proposed project period:
Amount of base $ 315,835 * x Rate applied 49.5 % = Indirect costs (a)
(1) Add to total direct costs form page 4 and enter new total on FACE PAGE, Item 7b.
(2) Add to total direct costs form page 5 and enter new total on FACE PAGE, Item 8b.

$ 49,769
$ 156,338

*Check appropriate box(es):
L Salary and wages base

Modified total direct costs base

E] Other base (Explain below)

U Off-site, other special rate, or more than one rate involved (Explain below)
Explanation (Attach separate sheet, if necessary.):
Please see following page for explanation of Modified Total Direct Costs base.

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PHS398 (Rev. 9/91)
This is the required last page of the application. Number it appropriately.

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