Memorandum of Understanding s20

EXAMPLE Memorandum of Understanding Faculty with Joint DVA/UCSF Appointments (6/2001 version)

This Memorandum of Understanding (MOU) is prepared in compliance with NIH guidelines for Department of Veterans Affairs (DVA) employees with joint University (UCSF) appointments applying for NIH support through UCSF. This MOU establishes the general distribution of effort for the faculty member named below who holds a joint appointment. It must reflect the time assigned to and available for the various responsibilities at the time of proposal submission. Information about current and pending research awards and how effort on those awards is apportioned within the time assigned to research is presented in the "Other Support" section of the NIH application. This completed and signed MOU must be attached to the Contracts and Grants Approval Form for the NIH proposal.

Name of Joint Appointee: Dr. Joint Appointee

I certify that the following estimates of the distribution of my effort at the DVA and at UCSF are true and accurate to the best of my knowledge.

Joint Appointee Signature: ______Date: ______

A. DVA Appointment: ( 8/8ths) ( 40 hours/week) DVA Service: Medicine DVA Appointment Title: Staff Physician

DVA Responsibilities: % of DVA Appointment % of Total Professional Hours Responsibilities Clinical: 20 50.0% 33.3% Administration: 5 12.5% 8.3% Teaching: 10 25.0% 16.7% Research: 5 12.5% 8.3% Other: DVA Totals 40 100% 67%

The information provided in A. represents a reasonable approximation of this individual's DVA responsibilities.

DVA Service Chief: ______Date: ______

B. UCSF Appointment: (12 months) UCSF Department: Medicine UCSF Appointment Title: Associate Professor

UCSF Responsibilities: % of UCSF Appointment % of Total Professional Hours Responsibilities Clinical: Administration: Teaching: Research: 20 100% 33.3% Other: UCSF Totals 20 100% 33%

The information provided in B. represents a reasonable approximation of this individual's UCSF responsibilities.

UCSF Department Chair: ______Date: ______