PUBLIC HEALTH APPLICATION FOR FUNDING

Transcription

1 EUROPEAN COMMISSION HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL Directorate G - Public Health, Luxembourg PUBLIC HEALTH APPLICATION FOR FUNDING European Commission Directorate for Public Health DG SANCO/G L-2920 LUXEMBOURG Fax: (352) Registration no: To be completed by the Commission Name of applicant organisation: Member State: Name of project leader: Title of project: Reference of call for proposals: Date of dispatch to the Commission: To enable us to deal with your dossier correctly, please indicate below the main subject area of this project (one cross at most) SANCO/G/2: [ ] [ ] [ ] SANCO/G/3: [ ] [ ] [ ] Cancer Drug addiction Pollution-related diseases Health education and/or promotion, information and training in the field of public health Prevention of accidents and injuries Health surveillance SANCO/G/4: [ ] [ ] AIDS and other communicable diseases Rare diseases

2 N.B. APPLICATIONS WHICH DO NOT COMPLY WITH THE FOLLOWING WILL BE REJECTED Applications for funding must be submitted in triplicate Applications submitted by fax or will not be considered Applications must be typewritten Unsigned applications will be rejected An guide for applicants can be found at the end of the form 2

3 PART ONE Administrative and budgetary information Mark a cross in the boxes which correspond exactly to your project FIELD OF ACTIVITY [ ] Cancer [ ] Drug addiction [ ] Pollution-related diseases SANCO/G/2 SANCO/G/3 [ ] Health education and/or promotion [ ] Information and formation in the field of health [ ] Health surveillance [ ] Deliberate and accidental injuries and accidents outside the workplace SANCO/G/4 [ ] AIDS and other communicable [ ] AIDS diseases [ ] Other communicable diseases [ ] Emerging diseases [ ] Surveillance network [ ] Rare diseases [ ] Establishment of European information network [ ] Training and updating of professional skills [ ] Promotion of transnational cooperation [ ] Surveillance of rare diseases at Community level 3

4 TYPE OF PROJECT Innovative approaches, pilot project, "model" project [ ] Evaluation and review [ ] Coordination of activity [ ] Feasibility studies [ ] Creation and operation of networks [ ] Conference [ ] Seminar [ ] Symposium [ ] Communication [ ] Other (please specify):... [ ] METHODS Primary prevention [ ] Secondary prevention, [ ] including screening [ ] Care, special schemes [ ] Social reintegration [ ] Public information [ ] Data collection [ ] Training [ ] Epidemiology [ ] Prevention policy, health care systems [ ] Health education [ ] Exchanges of information and experience [ ] Other (please specify):... [ ]

5 Is the project complementary to a project previously supported by the Commission? YES [ ] NO [ ] Is it a new project? YES [ ] NO [ ] Are other partners involved? YES [ ] NO [ ] If so, please turn to part 2 item 5 What other Member States are involved? [ ] Austria [ ] Italy [ ] Belgium [ ] Luxembourg [ ] Denmark [ ] Netherlands [ ] Finland [ ] Portugal [ ] France [ ] Spain [ ] Germany [ ] Sweden [ ] Greece [ ] United Kingdom [ ] Ireland What other, non-member countries are involved? PROPOSED TIMETABLE Planned start of project: Duration of project (number of months): 5

6 GENERAL INFORMATION ON THE APPLICANT Name of applicant: Name of legal representative: Abbreviation: Legal form: Public/quasi-public [ ] Private [ ] Non-profit-making [ ] Address: Number/street: Postcode: Town: Country: Tel. 1: Tel. 2: Fax 1: Fax 2: Registration number: Tax or VAT number: (or proof of VAT exemption) Are you part of a European network? YES [ ] Which?... NO [ ] Contractual representative of the project: - Surname: - Forename: - Title: - Function: - Telephone: - Fax: Project leader: - Surname: - Forename: - Title: - Function: - Telephone: - Fax: 6

7 BANK INFORMATION Attach original of customer/account identification, i.e. a document from the bank giving the applicant's name and address, the name and address of the bank and the full bank account number Name of the bank: Abbreviation: Branch: Address: Number/street Postcode: Town: Country: Account number: Bank code: SWIFT code: PREVIOUS SERVICES/GRANTS Has the applicant already received grants from the Commission? If YES: YES [ ] NO [ ] Type and number of contract Commission department Year Amount in euro Please enclose a copy of the first page of the summary and the first page of the abstract of each final technical report submitted to the Commission 7

8 ESTIMATED BUDGET IN EURO EXPENDITURE INCOME DIRECT ELIGIBLE COSTS (D) - Personnel costs... - Travelling and subsistence expenses:... - Miscellaneous services:... - Administration... - Reserve for unexpected costs... INDIRECT ELIGIBLE COSTS (I) - General costs... - Commission (funding requested) (S) (maximum 70% of eligible costs)... - Contribution pertaining to national officials... - Applicant's financial contribution (C)... - Income generated by the project: (R) Fees... Document sales Other external resources (R) (financial support already obtained) Other current funding applications (R) CONTRIBUTION IN KIND (K) (acceptable for calculating total cost) - Unpaid voluntary work by physical person or legal entity:... CONTRIBUTION IN KIND (K)... - Contributions in kind essential to the implementation of the project:... GRAND TOTAL (D+I+K)... GRAND TOTAL (C+R+S+K)... 8

9 DETAILS OF ESTIMATED EXPENDITURE DIRECT ELIGIBLE COSTS: costs directly linked to the project (D) PERSONNEL COSTS Fees: (number of persons and functions x daily rate x number of days) SUB-TOTAL : Personnel costs pertaining to national officials (function/number of persons x daily rate x number of days) SUB-TOTAL : (to be indicated under Income: contribution pertaining to national officials ) Secretarial costs: (number of persons x daily rate x number of days) SUB-TOTAL : Other personnel costs: (number of persons and functions x daily rate x number of days) SUB-TOTAL : TOTAL PERSONNEL COSTS.. EURO 9

10 TRAVEL/ACCOMMODATION/SUBSISTENCE Travel expenses (for each journey: purpose/means of transport/place of departure/destination/cost) SUB-TOTAL : Subsistence purpose/place/number of days per trip x daily cost x number of persons) SUB-TOTAL : TOTAL TRAVEL/SUBSISTENCE.. EURO 10

11 MISCELLANEOUS SERVICES Information costs (e.g.: printing, computer support, conference programme, distribution) Costs of reports/translation Subcontracting Interpreting costs Audit/evaluation costs Other services (please specify) TOTAL MISCELLANEOUS SERVICES.. EURO 11

12 PROJECT ADMINISTRATION Equipment (Purchase, rent or leasing) Purchase/rent of real estate Cost of consumables and supplies directly necessary for project implementation (postage/telephone/fax/office supplies) Cost of financial services: (cost of banking transactions, insurance) Cost of certificates/sureties (bank guarantee) TOTAL PROJECT ADMINISTRATION 12.. EURO

13 RESERVE FOR UNEXPECTED COSTS Maximum 5% of direct eligible costs (personnel costs + travel/subsistence + miscellaneous services + project administration) TOTAL RESERVE FOR UNEXPECTED COSTS.. EURO INDIRECT COSTS (GENERAL) INDIRECT ELIGIBLE COSTS (I) Maximum 7% of total of personnel costs + travel/subsistence + miscellaneous services + project administration (Please list) TOTAL INDIRECT ELIGIBLE COSTS.... EURO 13

14 CONTRIBUTION IN KIND (K) (but acceptable for calculating the total cost of the project) Contributions in kind essential to the implementation of the project (e.g. rooms/translations/interpreting/social events) Voluntary, unpaid work by a private individual (physical person or legal entity) (function/number of persons x daily rate x number of days) (amount to be indicated under Income: contribution in kind by the applicant, page 6) GRAND TOTAL (D+I+K).. EURO N.B. : If these tables are too small, please provide appropriate tables based on the same model. 14

15 PART TWO Detailed description of the project (In French, English or German if possible) (Sections to be completed irrespective of field of activity) N.B. Do not write outside the boxes or add extra pages. 1) Statement of project aims 2) How does your project relate to what has already been done in the field? 15

16 3) Description of tasks/sequence of work/timetable (This section must be completed with great care as it will be incorporated into the contract to be signed by the applicant if the project is approved) N.B. Do not write outside the box 16

17 4) Applicant's ability to attain the objectives set (Experience, facilities, etc.) 1. Curriculum vitae of the person responsible for the project (to be attached separately) 2. If the applicant is a corporate body, a copy of the document by which it was constituted (to be attached separately) 3. Brief description of the applicant body (aims, previous and current activities, etc.) N.B. Do not write outside the box 17

18 5)Partnership: State name, address, telephone and fax numbers of bodies from other Member States taking part in the project Please attach a letter of intent from the partners attesting to their participation in the project 6) Community dimension and Community added value (please provide full details) 7) Expected results of the project N.B. Do not write outside the boxes 18

19 8) Assessment and follow-up of the project (provide details of funding expected for this activity at the end of the current project) 9) Utilisation and dissemination of results among the scientific community and the general public 10) Methods N.B. Do not write outside the boxes 19

20 Incomplete or incorrectly completed forms will be disregarded. If the application is accepted, the applicant undertakes to indicate on all documents resulting from the project (brochures, books, posters, etc.) that the project has received financial support from the European Commission. The applicant confirms that he is aware of all the conditions under which any Commission funding is granted. The applicant solemnly declares that the information provided to the Commission in this document is true. Date: Signature of legal representative preceded by the words "Read and approved": Name of signatory: 20

21 GUIDE FOR APPLICANTS DIRECT ELIGIBLE COSTS = Additional costs arising directly from the implementation of the project and essential thereto PERSONNEL COSTS The fees must be calculated according to the number of persons/number of days/daily rate applied, and should be based on a maximum total of 220 days worked per year. The daily rates will be based on the annual wages of staff and may not under any circumstances exceed the usual wages and other costs normally paid or incurred by the applicant. Supporting documents are to be provided together with the final account. Costs must be limited to operational personnel (not officials) directly involved in the project. TRAVEL EXPENSES Details of travel must be provided, i.e. for each trip the purpose, means of transport, place of departure, destination and cost must be given. With regard to project-related travel, the beneficiary (or contractor) should preferably use APEX or, in exceptional circumstances, Eurobudget tickets upon presentation of supporting documents. The standards to be applied for travel costs are as follows: - rail: first class - air: only in excess of 400 km one way - car: on the basis of the first-class rail fare. For all travel to a destination outside: - the Member States of the European Union - the European Economic Area - the applicant countries - international institutions based in Geneva prior authorisation must be obtained from the Commission. 21

22 SUBSISTENCE EXPENSES The maximum acceptable daily rates are as follows: Austria Italy Belgium Luxembourg Denmark Netherlands Finland Portugal France Spain Germany Sweden Greece United Kingdom Ireland These allowances cover meals, accommodation and local travel costs (taxi, bus, etc.). No derogations will be accepted. MISCELLANEOUS SERVICES Please provide a detailed estimate for each amount under this heading. - Distribution costs: These must be broken down by number of copies x unit reproduction cost. - Translation costs: Please indicate the nature of the document(s) translated, the original language of each document, the languages translated and details of the calculation per document (number of pages x cost/page). - Subcontracting: only for subcontractor(s) explicitly referred to in the grant agreement the rules applicable to the recipient also apply to the subcontractor. - Interpreting costs: Please state the purpose, the languages interpreted and the calculations (number of persons x number of days x cost per day). - Audit/evaluation costs: Audit/evaluation costs in connection with the project. PROJECT ADMINISTRATION - Equipment necessary for implementing the project: In the case of rental or leasing, please state the cost per month x number of months of the project and attach a copy of the rental or leasing contract. In the case of purchase, please submit the estimate or invoice. The depreciation period will be three years for computer equipment and five years for any other equipment (e.g. furniture). - Cost of consumables and supplies 22

23 Please give details of the calculation for each item of expenditure (amount per month x number of months of the project). - Cost of financial services Please note that currency exchange charges are not taken into account. 23

24 MISCELLANEOUS INFORMATION There can be no duplicate Community funding. The amount of the grant applied for is strictly limited to the minimum necessary for implementation of the project. A bank guarantee will be required for all advance payments exceeding euro, except in the case of public and quasi-public organisations. Where appropriate, the advance payment will be limited to 10% of the grant, followed by two interim payments and a final payment. General costs may not exceed 7%. NON-ELIGIBLE (AND UNACCEPTABLE) DIRECT COSTS: contributions in kind not essential to project implementation costs which would have been incurred even if the project had not taken place costs not related to project implementation costs not necessary for project implementation expenditure on luxuries costs which do not reflect market conditions costs not entered in the accounts (with the exception of indirect eligible costs) costs not identifiable (with the exception of indirect eligible costs) non-verifiable costs (with the exception of indirect eligible costs) reserves of a general nature (except eligible reserves for unexpected direct costs) invested capital costs debts owed, interest on debts owed, bad debts receivable exchange rate losses reserves for unexpected costs in excess of 5% of D1 costs expenditure outside the contract period (non-compliance with minimal rules on dates: the grant may cover only expenditure after the date of submission of the application and after 1/1 of the financial year in question). NON-ELIGIBLE (AND UNACCEPTABLE) INDIRECT COSTS: all general costs for organisations already in receipt of a grant general costs exceeding 7%. 24

25 LIST OF DOCUMENTS TO BE SUBMITTED APPLICATION FOR FUNDING Copy of articles of association and certificate of official registration Annual accounts (or annual budget for public-sector organisations) for the last financial year, for projects involving an EC grant < euro Annual accounts (or annual budgets for public-sector organisations) for the last three financial years for large-budget projects involving an EC grant exceeding euro OR Audit certificate issued within the last two years, for large-budget projects involving an EC grant exceeding euro Official document showing VAT N of applicant or, where appropriate, proof of exemption Original bank account identification document, i.e. a document from the bank stating the name and address of the applicant organisation, the name and address of the bank and the full account number supporting documents confirming the fees paid to personnel (for example a copy of a salary slip, contract and/or salary grid) Cost forecasts (quotes for travel, information dissemination costs, translations, interpretation, subcontracting, project administration etc.) Explicit undertaking by the applicant to assume responsibility for funding in the event of default by other parties providing funding Letters of intent from partners attesting to their participation in the project List of grants obtained by the organisation during the last three years, and copies of the first page of the summary and the first page of the abstract of each final technical report addressed to the Commission Documents showing the level of competence in the field, the applicant's professional experience in the fields at European level, and the capability to carry out all the activities proposed for the project Complete and detailed C.V. of proposed project leader 25