Seattle Children's Urologic Management to Preserve Initial Renal Function Protocol for Young Children with Spina Bifida (UMPIRE Protocol) (Component C)

Seattle Children'S Hospital, Seattle WA

Investigators

Abstract

0MB Number: 4040-0001 Exnlratlon Date: 10/3112019 APPLICATION FOR FEOERAL ASSISTANCE SF 424 (R&R) 1. TYPE OF SUBMISSION D Pre-application cg] Application D Changed/Corrected Application 2. DATE SUBMITTED I I 3. DATE RECEIVED BY STATE I I 4. a. Federal Identifier b. Agency Routing Identifier c. Previous Grants.gov Applicant Identifier I State Application Identifier Tracking ID 5. APPLICANT INFORMATION Organizational DUNS: lo486821s10000 I · Legal Name: jseattle Children I s Hospital I Department: [ I Division: I I Street1: l·soo Sand Po~nt Way NE I Street2: f I City: lseattle ICounty I Parish: I I State: I WA: Washington I Province: I I Country: I USA: UNITED STATES I ZIP / Postal Code: 198105-3901 I Person to be contacted on matters !nvolvlng this application Prefix: lor. I First Name: !James I Middle Name: IB. I Last Name: [Hendricks . 1 Suffix: I Pos!tionffitle: !President, Research Institute I Street1: j1900 Ninth Avenue I Street2: IM/S 818-S I City: lseattle ICounty I Parish: [King I State: I WA: Washington I Province: I I Country: I USA: UNITED STATES IZIP/ Postal Code: 198101-1309 I Phone Number: 1206-884-7478 I Fax Number: 1206-884-1597 I Email: lresactmin@seattlechildrens.org I 6. EMPLOYER IDENTIFICATION (EIN) or/TIN): 191-0564748 I 7. TYPE OF APPLICANT: f M: Nonprofit with 501C3 IRS Status (Other than Institution of Higher Education) I Other (Specify): I l Small Business Organlzation Type D Women Owned D Socially and Economically Disadvantaged If Revision, mark appropriate box(es). DA. Increase Award DB. Decrease Award c. Increase Duration DD. Decrease Duratton DE. Other (specify):I I 8. TYPE OF APPLICATION: cg] New D Resubmission D Renewal D Continuation Revision Is this appllcatlon being submitted to other agencies? Yes O No rgj What other Agencies? I 9. NAME OF FEDERAL AGENCY: !Centers for Disease Control and Prevention - ERA 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:!93. 315 TITLE: IRare Disorde:i:·s: Research, Surveillance, Health Promotion, and Education 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: !Seattle Children's Urologic Management to Preserve Initial Renal Function Protocol for Young Children with Spina Eifida (UMPIRE Protocol) (Component C} 12. PROPOSED PROJECT: Start Date Ending Date I 09/01/2019 11 0013112024 13. CONGRESSIONAL DISTRICT OF APPLICANT lwA-007 II 9001050 11 SF 424 (R&R) APPLICATION FOR FEDERAL ASSISTANCE Page 2 14. PROJECT DIRJ;CTOR/PRINCIPAL INVESTIGATOR CONTACT INFORMATION Prefix: -~r. I First Name: lwilliam I Middle Na~m_e_:_Ll:,o=t=i=s===;--------'I Last Name: 11!'.w;al'.:k=·=r================,------'lSuffix: cclJ-r'-.- - - ~ ' Position/Title: IL---;:===============:_I_____-----, Organization Name: jseattle Children I a Hospital I Pepartmen.:t:11::============c.._l_:D:_:iv:_:is:_:lo_n_:=====;--------'I Street1: [4a()o sand J?oint Way NE I Street2:, I I s============;-:--:--~~==-------- CIty: lseattle j County/ Parish: I I State: I WA, Washington j Prmilnce: l'------;===========lc..__~ Country: ~,=====,====U=SA=,=UN::'I::'T::'E::'D::'S:::T::'A::'TE=S========;Z-'I,P/ Postal Code: '9-'8-0l'-5'---..C.3_90__1 _ _ _ _ _ _ _~1 Phone Number: j206-981-2000 j Fax Number: 1206-987-7818 I Email: lwilliam. walker@seattlech>ildrens ,org 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS? a. YES O TNIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON: DATE: I I b. NO [8;l PR~.GRAM IS NOT COVERED BY E,O. 12372; OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW 15. ESTIMATED PROJECT FUNDING 1-------------;::========;-I a. Total Federal Funds Requested I 102, 495_ ool b. Total Non~Federal Funds I o.ool c. Total Federal & Non·Federal Funds I 102,495.001 d, Estimated Program Income I o. ool 17. By signing this application, I certify {1) to the statements contained in the list of certifications* and (2) that the statements herei~ 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 181 Section 1001) ~ I agree *The llsf of certifications and assurances, or an Internet site where you may obtain this /Isl, Is contained In tho announcement or agency specific instructions. 18. SFLLL (Dfsclosure of Lobbying Activities) or other Explanatory Documentation lrl.~. ~/-id~)~,,~\t=~c~b~.in-e~Qt-,·~11 )ji,1~te/\Uaq1Jrni,of·.11 ·· Vi~WAitaclirrteni ·. I 19. Authorized Representative Prefix: lor. I First Name: !James I Middle Name: la. I ~-====::::;------' Last Name: !Hendricks 7 Suffix: I I '--;:::==============~----' '------1 Pos1tlon[fltle: !President, Research Institute I Organization: [seattle children 1 s Hospital Department l~===========:'_ID_1v_1s_1o_n_,:======:;--_____Jl Street1: 11900 Ninth Avenue ! Street2: IM/S 818-s I ~_2::===========,--:-::-:--====!...----- City: lseattle ! County/ Parish: I I State: I WA, Washington I Province: I I Country:·'-;1=======::::0S=A=,=U=N=I=T=ED=S=TA=T=E=S=========:C::1 ZIP I Post'.:a:-:1C::-o:-:d::-e_~,;:::9=81=0=1=-=13=0=9======'---~, Phone Number: !206-884-7478 I Fax Number: !206-884-1597 ! Sitmature of Authorize ~1,~;;;;;;;=~-~I Date Signed Email: lresadmin@seattiechildrens, or ,~·.,. ,,,/,/, / . ;/S 9: C . Aotlnpil'l~~half o( ... I .'3·/,~--··· }It>. 4 / ~ ·l.C ····.. ·· .Jarp~fi·~. l::lendricki,, !'hD,Pres dent . ·1 20. Pre-application I~==============~ l~~d~t!ll<llil)1e6t 11 Del~i~A1t~chljii,iiti I' \/le,W/\tfa~fai~ertt J 21. Cover Letter Attachment le Cover Letter 2019. pd£ 11;.AM'Maohriient I loelet~)l.ttacllrrifjj] 11,~wAttaqh!iJen(I I Seattle Children's HOSPITAL · RESEARCH · FOUNDATION Division of Developmental Medicine Department of Pediatrics Seattle Children's Hospital January 23, 2019 Office of Grant Services Centers for Disease Control and Prevention 2920 Brandyv,,ine Road, GHSecB, Team 1 Atlanta, GA30341 RE: RFA-DD-19-001 To Whom It May Concern: Please accept this proposal entitled Urologic Management to Preserve Initial Renal Function Protocol for Young Children with Spina Bifida (UMPIRE Protocol). This proposal is being submitted in response to the recent RFA-DD-19-001 entitled Research Approaches to Improve the Care and Outcomes of People Living with Spina Bifida. Please contact me at the phone number or email address belowwith any questions regarding this proposal. Thank you, William 0. Walker, Jr. MD Chief, Division of Developmental Medicine Robert A. Aldrich Endowed Professor, Pediatrics University ofWashington School of Medicine Seattle Children's Hospital Phone 206-987-2590 FAX 206-987-3824 William .Walker@SeattleChildrens.org Contact PD/Pl: Walker. William 0 424 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