April 22, 2008



Proprietary Information Notice for Reviewers FORMCHECKBOX No proprietary information is included in this UB CAT Application FORMCHECKBOX All proprietary information is either identified in the body of the UB CAT Application with a “CONFIDENTIAL” notation or included as an appendix to the UB CAT ApplicationUB CAT Project Title:UB Principal Investigator:[Name][Title][Department][Phone][Email]Private Sector Company Sponsor (“Sponsor”)Full Legal Name:Number of Company Employees:Address of Principle Office / Facility:[Address][City, State Zip Code]Does the Company have a New York State Office / Facility? ?Yes?NoDoes the Research Proposed Require IACUC Approval??Yes?NoDoes the Research Proposed Require IRB Approval??Yes?NoDoes company have at least 1 NYS FTE*, based on the definition below? ?Yes?NoDoes the UB Principal Investigator have an annual conflict of interest disclosure on file??Yes?NoDoes the UB Principal Investigator have a vested interest in the company??Yes?NoWill the project use radioactive materials??Yes?No*Definition of Full Time Employee: Employee working in NYS location for a minimum of 35 hours/week. Company must be able to provide proof of employment upon request. Sponsor Contact:[Name][Title][Phone][Email]Have you previously received UB CAT / NYSTAR funding? ?Yes ? NoIf Yes, please indicate the results of the previous project, including specific deliverables:Project Budget Summary:Private Sector Sponsor Cash (or equivalent):$ Match Ratio: <100 employees = $1.00 CAT/ $1.50 Company>100 employees = $1.00 CAT/ $3.00 CompanyWhen using a subcontracted SBIR, STTR federal award as match, the minimum match is $1.00 CAT / $2.00 federal award. UB CAT / NYSTAR Cost Sharing:$TOTAL PROJECT COST:$Status of Sponsor Cash:?In Hand ? Other, please explain: Anticipated Economic Development Impact (over next five years):Required Years of ReportingNew Jobs CreatedRetained JobsAcquisition of Federal Funding*Acquisition of Non-government Funding **Increased Company RevenuesCost Savings***Capital Expenditures****2021 – 2025* SBIR, STTR, DoD, NIH, NSF or other federal funds** Venture capital, angel investor or stock proceeds*** Savings compared to alternative work plans, value of special equipment or expertise, and other savings**** Purchases of equipment, construction or renovation of facilities by the company specifically initiated by the UB CAT projectPlease provide a response to the information requested as it applies to this project application. Please provide a complete yet concise response to the information requested as it applies to this project application.? The length admissible for each section is at the discretion of the principal investigator or company sponsor.1. Company background and technology/expertise brief:2. Market or commercial opportunity (describe relevance of project to creation of new products and services and/or improvement on existing products and services; provide quantitative information on market size and revenue where possible; include detailed information on target customer, competition and product): 3. Purpose of project and how it addresses the big data and health sciences focus area (non-proprietary & in layman’s terms):4. Applied research to be performed, including specific aims/milestones:5. Timeframe for completing project milestones:6. Describe Disclosure/Patent Status of Any Intellectual Property Involved in this project:7. Detailed Project Budget:Include total project budget (CAT funding and company match combined)All project expenses must adhere to SUNY RF purchasing policies and guidelines):Budget ItemsProjected CostUB Personnel Costs Faculty, Researchers, or Students (Include % Effort)Salary$0 Fringe57.71% SUNY Employees IFR14% SUNY Summer Only Appointment41% Research Foundation Employee25% Research Foundation Post-Doctoral Employee16% Graduate Student5% Undergraduate Student$0 Indirect Rate: 15% of Salary + Fringe (applied to UB Personnel costs)$0 ??Equipment Purchases (item > $5,000):????????? ?$0 Materials and Supplies:????????? ?$0 Other Expenses:????????? ?$0 TOTAL PROJECT COST = $0 Company Signature: ___________________________________________________________________Company Name and Title: _______________________________________________________________UB Principal Investigator Signature: ________________________________________________________UB Principal Investigator Name: ___________________________________________________________Please submit final application to ubcatprogram@buffalo.edu by May 6, 2020. ................
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