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

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DEPARTMENT OF HEALTH AND HUMAN SERVICES 1EVE BLANK FOR PHS USE ONLYk'4M '.'
PUBLIC HEALTH SERVICE T ypi A'f (Activit 4ANLAmtier,
GRANT APPLICATION Seview GoiForiroupT
Follow instructions carefully. Type in the unshaded areas only. Council/Board (Month~ Year); s 4 Date Received,;G
Animal Tests of the AIDS Risks of Nitrite Inhalants
2a.~ RESPONSE TO SPECIFIC REQUEST FOR APPLICATIONS OR PROGRAM ANNOUNCEMENT Z No YES ('lf "YES,"state number
Number: Title AIDS Res earch and title)
2b. TYPE OF GRANT PROGRAM R 01 '73. PRINCIPAL INVESTIGATOR/PROGRAM DIRECTOR
3a. NAME (Last, first, middle).,3b. DEGREE(S). 3c. SOCIAL SECURITY NO.
DUESBERG, Peter H. PhD 1564-72-3481
3d. POSITION TITLE..3e. MAILiNG ADDRESS (Street, city, state, zip code)~
Prof essor Virus Laboratory
3f.>DEPARTMENT, SERVICE, LABORATORY, OR EQUIVALENT 2 29 Wende ll M. Stanley Hall
Virus Laboratory University of California
3g. MAJOR SUBDIVISION Berkeley, CA 9 472 0
College of Letters & Science
3h. TELEPHONE AN D FAX (Area code, number and extension)
TEL: [phone]
FAX: ( 510 ) 6 43-6 4 55 BITNET/INTERNET ADDRESS
4. HMNSBETIRB 5. VERTEBRATE ANIMALS If "Yes," Sb. Animal welfare
HU ANSU JETSIf "Yes," approval 4b. Assurance of IACUC approval date assurance no.
4a. exemption no. or date compliance no. S a.
x NO ~YES NO X YES pending 'A3084-01
6. DATES OF ENTIRE PROPOSED PROJECT -7. COSTS REQUESTED FOR INITIAL 8. COSTS REQUESTED FOR ENTIRE
PERIOD BUDGET PERIOD PROPOSED PROJECT PERIOD
From (MMDDYY) Through (MMDDYY) 7a. Direct Costs ($) 7b. Total Costs ($) 8a. Direct Costs ($) 8b. Total Costs ($)
020194. 013197 $190,973 $240,742 -$603,313 $759,651
9. PERFORMANCE SITES (Organizations and addresses) 10.INVEPNTRIOONMS AND DPAT ENTS (Competing continuation application only)
Virus Laboratory -
If - Previously Not previously
Wendell M. Stanley Hall NO YES 'YES,"~ reported reported
Univers ity of Calif ornia 1.NAME OF APPLICANT ORGANIZATIONBerkeley, CA 94720 Regents of the Univ Calif Berkeley
ADDRES c/o Sponsored Projects Office
Inst of Toxicology & Env H~th '336 Sproul Hall
University of California University of California
Davis,' CA 95616 -'" Berkeley, CA 94720
12 TYPE OF ORGANIZATION R3ENTITYLIDENTIFICATION NUMBER ConreIssional District
3Pblic Speciy OF>~,.i slat 19 4 60 0212 3A1 -. 8
P iat pf t:&..j. 14 BIOMEDICAL. RESEARCH SUPPORT GiRANT CREDIT....O Forpofit (Geher~ Oi i:Foprfit (Small Busin ess) C-"~ ode 20 Ideitifl6 ion~- Other Academic
15. NAME OF ADMINISTRATIVE OFFICIALTO BE NOTIFIED IF AWARD 16 ME OF OFCIAL SIGNING FOR APPLCTO
Jyl Baldwin JIlMAldwE
t 3,P [phone] TLeMAS [phone]
WiI(510) 642-8236 ~AXpt(510) 642-8236
T~Tf.
Research Administrator i Research Administrator
ADDRESS Sponsored Projects Office Es DDponsored Projects Office
336 Sproul Hall 336 Sproul Hall
university of California University of California
Berkeley, CA 94720 Berkeley, CA 94720
FAX:13@10a43-6455yed BITNET/NETDRESS
4. HUMN EUBECTS I5P0013@cmsBANIMAOL3@cmsa, aberkele e

17. PRINCIPAL INVESTIGATOR/PROGRAM DIRECTOR ASSURANCE: I agree to accept respon- SIGNATURE OF PERSON NAMED IN 3a. DATE
sibility for the scientific conduct of the project and to provide the required progress reports if a grant (In ink. "Per" signature not acceptable.)
is awarded as a result of this application. Willful provision of false information is a criminal offense
(U.S. Code, Title 18, Section 1001). 1 am aware that any false, fictitious, or fraudulent statement}.
may, in addition to other remedies available to the Government, subject me to civil penalties under
the Program Fraud Civil Remedies Act of 1986 (45 CFR 79).
18. CERTIFICATION AND ACCEPTANCE: I certify that the statements herein are true and complete SIGNATURE OF PERSON NAMED IN 1 DATE
to the best of my knowledge, and accept the obligation to comply with Public Health Service terms (In ink. "Per"signature not acceptable.)
and conditions if a grant is awarded as the result of this application. A willfully false certification is
a criminal offense (U.S. Code, Title 18, Section 1001). 1 am aware that any false, fictitious, or
fraudulent statement may, in addition to other remedies available to the Government, subject me
to civil penalties under the Program Fraud Civil Remedies Act of 1986 (45 CFR 79).

PHS 398 (Rev. 9/91)

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