Please provide Institution Number/Project Number Please visit the EH&S link below for more or specific details of each information regarding the University’s process for the use of Select Agents. Use and transfer of *If there are any other agreements which in any Select Agents requires written approval of EH&S. way relate to the Material, the Office of Research must review the terms of these agreements to ensure that such agreements do not contain any For the Select Agent list: restrictions which would prohibit the University from transferring the Material. 9. Do you require reimbursement for the cost to Scope of Work: provide Materials? In order for the Office of Research to draft the Yes (explain)/No/ Shipping only outgoing MTA, the recipient scientist will need to supply a scope of work detailing his/her use of the *If Yes, please provide an explanation of such Materials. This scope of work should be reviewed costs. and approved by the Pitt PI and should be entered Note: Costs charged must total exact costs spent onto the submission form at the bottom of the to provide Materials. right column or attached as a separate document. In the event the PI desires recovery of costs, additional language must be added to our standard MTA. 10a. Do you require the recipient PI to share results back with you? Yes/No * If you will require that the recipient PI share back his/her results from the research using the Material, additional language must be added to the MTA. 10b. Is this a collaboration with the recipient? Yes/No * If the Material is provided to the recipient as part of a collaboration, a different form of agreement may be more appropriate. 10c. Do you desire joint publication of the resulting data? Yes/No *If joint publication is desired, a different form of agreement addressing joint publication may need to be used in lieu of the standard outgoing MTA. Signature Section: *Principal Investigator must be a University of Pittsburgh faculty member. This form can either (1) be signed by the PI and submitted on behalf of the PI; (2) be left unsigned if the PI himself/herself is submitting the form directly to the Office of Research; or (3) be left unsigned if the form is being submitted on behalf of the PI provided that the PI has indicated his/her approval of the contents of the submission form.
Please provide Institution Number/Project Number or specific details of each *If there are any other agreements which in any way relate to the Material, the Office of Research must review the terms of these agreements to ensure that such agreements do not contain any restrictions which would prohibit the University from transferring the Material. Please visit the EH&S link below for more information regarding the University’s process for the use of Select Agents. Use and transfer of Select Agents requires written approval of EH&S. For the Select Agent list: 9. Do you require reimbursement for the cost to provide Materials? Yes (explain)/No/ Shipping only *If Yes, please provide an explanation of such costs. Note: Costs charged must total exact costs spent to provide Materials. In the event the PI desires recovery of costs, additional language must be added to our standard MTA. Scope of Work: In order for the Office of Research to draft the outgoing MTA, the recipient scientist will need to supply a scope of work detailing his/her use of the Materials. This scope of work should be reviewed and approved by the Pitt PI and should be entered onto the submission form at the bottom of the right column or attached as a separate document. 10a. Do you require the recipient PI to share results back with you? Yes/No * If you will require that the recipient PI share back his/her results from the research using the Material, additional language must be added to the MTA. 10b. Is this a collaboration with the recipient? Yes/No * If the Material is provided to the recipient as part of a collaboration, a different form of agreement may be more appropriate. 10c. Do you desire joint publication of the resulting data? Yes/No *If joint publication is desired, a different form of agreement addressing joint publication may need to be used in lieu of the standard outgoing MTA. Signature Section: *Principal Investigator must be a University of Pittsburgh faculty member. This form can either (1) be signed by the PI and submitted on behalf of the PI; (2) be left unsigned if the PI himself/herself is submitting the form directly to the Office of Research; or (3) be left unsigned if the form is being submitted on behalf of the PI provided that the PI has indicated his/her approval of the contents of the submission form.
Instructions%20for%20Outgoing%20MTA%20Submission%20Form_11.2013.docx