0MB Number: 4040--0001 Expirat[on Date: 06/30/2016 APPLICATION FOR FEDERAL ASSISTANCE SF 424 (R&R)3. DATE RECEIVED BY STATE IState Application Identifier 1. TYPE OF SUBMISSION* 4.a. Federal Identifier 0 Pre-application Application 0 Changed/Corrected Application b. Agency Routing Number 2. DATE SUBMITTED IApplication Identifier 2019-03-08 P0537049 c. Previous Grants.gov Tracking Number 5. APPLICANT INFORMATION Organizational DUNS*: 0948783370000 Legal Name*: The Regents of the University of California, San Francisco Department: Division: Office of Sponsored Research Street1*: 3333 California Street Street2: Suite315 City*: San Francisco County: State*: CA: California Province: Country*: USA: UNITED STATES ZIP/ Postal Code*: 941186215 Person to be contacted on matters involving this application Prefix: Mrs. First Name*: Estrella Middle Name: C. Last Name*: Garcia Suffix: Position/Title: Contracts & Grants Officer Street1*: 1001 Potrero Ave Street2: Bldg 20, nn 2407 City*: San Francisco County: San Francisco State*: CA: California Province: Country*: USA: UNITED STATES ZIP/ Postal Code': 941103518 Phone Number: +1415 260-5128 Fax Number: 4152605128 Email: estrella.garcia@ucsf.edu 6. EMPLOYER IDENTIFICATION NUMBER (EIN) or {TIN)' 1946036493A6 7. TYPE OF APPLICAN,: H: Public/State Controlled Institution of Higher Education other (Specify): Small Business Organization Type 0 Women Owned 0 Socially and Economically Disadvantaged 8. TYPE OF APPLICATION* eNew 0 Resubmission 0 Renewal 0 Continuation 0 Revision If Revision, mark appropriate box(es). 0 A. Increase Award 0 B. Decrease Award 0 C. Increase Duration 0 D. Decrease Duration 0 E. other (specify) : Is this application being submitted to other agencies?* OYes eNo What other Agencies? 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER 93,283 TITLE: Centers for Disease Control and Prevention Investigations and Technical Assistance 9. NAME OF FEDERAL AGENCY* Centers for Disease Control and Prevention - ERA 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT* Racial/etlmic and socioeconomic disparities in biologic and clinical SLE outcomes 12. PROPOSED PROJECT Start Date Ending Date* 09/01/2019 08/31/2022 13. CONGRESSIONAL DISTRICTS OF APPLICANT CA-012 90010506 lmding Opportunity Number: RFA-DP-19-003. Received Date: Tracking Number: Page 1 Contact PD/Pl: Dall'Era, Maria SF 424 (R&R) APPLICATION FOR FEDERAL ASSISTANCE Page 2 14. PROJECT DIRECTOR/PRINCIPAL INVESTIGATOR CONTACT INFORMATION Prefix: Dr. First Name*: Maria Middle Name: Last Name*: Dall'Era Suffix: M.D. Position/Title: Professor Organization Name*: The Regents of the University of California, San Francisco Department: Medicine Division: School of Medicine Street1 *: 533 Parnassus Ave, rm 386 Street2: City': San Francisco County: State': CA: California Province: Country*: USA: UNITED STATES ZIP/ Postal Code*: 94143-2205 Phone Number': +1415476-0783 Fax Number: Email*: Maria.DallEra@ucsf.edu 15. ESTIMATED PROJECT FUNDING a. Total Federal Funds Requested* $2,700,000.00 b. Total Non-Federal Funds* $0.00 c. Total Federal & Non-Federal Funds* $2,700,000.00 d. Estimated Program Income* $0.00 16.IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS?* a. YES Q THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON: DATE: b.NO e PROGRAM IS NOT COVERED BY E.O. 12372; OR Q PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW 17. By signing this application, I certify (1) to the statements contained in the list of certifications* and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances * and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001) I agree* *The/1st of cer/lflcations and assurances, or an Internal site where you may obtain this list, Is contalrwd In the announcement or agancy Sf18Giflc Instructions. 18. SFLLL or OTHER EXPLANATORY DOCUMENTATION File Name: 19. AUTHORIZED REPRESENTATIVE Prefix: Mrs. First Name*: Estrella Middle Name: C. Positionrritle*: Contracts and Grants Officer Organization Name*: The Regents of the University of California, San Francisco Department: Research Management Services Division: Office of Sponsored Research Street1*: 3333 California Street, Room 435 Street2: City*: San Francisco County: San Francisco State*: CA: California Province: Country*: USA: UNITED STATES ZIP/ Postal Code*: 941431241 Phone Number*: +1415260-5128 Fax Number: Signature of Authorized Representative* Mrs. Estrella C. Garcia Last Name*: Garcia Suffix: Email*: Estrella.Garcia@ucsf.edu Date Signed* 03/08/2019 20. PRE-APPLICATION File Name: 21. COVER LETTER ATTACHMENT File Name: Tracking Number: GRANT12812036 Funding Opportunity Number: RFA-DP-19-003. Received Date: Page 2 2019-03-08T14:09:47.000-05:00 Contact PD/Pl: Dall'Era, Maria 424 R&R and PHS-398 Specific Table Of Contents SF 424 R&R Cover Page...................................................................................................1 Table of Contents .......................................................................................................3 Performance Sites ........................................................................................................4 Research & Related Other Project lnformation ...............................................................6 Project Summary/Abstract(Description).........................................................................7
......................................................................................................8 Facilities & Other Resources.......................................................................................9 Research & Related Senior/Key Person ..............................................................................15 Research & Related Budget Year 1.................................................................................45 Research & Related Budget Year 2.................................................................................48 Researcfl & Related Budget Year 3.................................................................................51 Budget Justification......................................................................................................54 Research & Related Cumulative Budget.........................................................................61 PHS398 Cover Page Supplement...................................................................................62 PHS 398 Research Plan ....................................................................................................64 Specific Aims ...............................................................................................................65 Research Strategy.......................................................................................................66 Progress Report Publication List..............................................................................91 PHS Human Subjects and Clinical Trials lnformation................................................93 Study 1: California Lupus Epidemiology Study (CLUES)........................................95 Inclusion Enrollment Reports...............................................................................100 Multiple PD/Pl Leadership Plan....................................................................................109 Bibliography & References Cited ..................................................................................110 Letters of Support...................................................................................................118 Resource Sharing Plan(s) ..........................................................................................129 Table of Contents Page 3
