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["LSU Health Sciences Center - New Orleans"]
["Clinical Trials Detailed Budget Worksheet"]
["THIS FILE IS FOR INTERNAL USE ONLY. CONTACT LSUHSC Clinical Trials Office WITH ANY COMMENTS OR QUESTIONS"]
[]
["PROJECT INFORMATION"]
["Project Title: "]
["Principal Investigator:",null,null,null,null,null,"Department"]
["Sponsor/CRO:",null,null,null,null,null,"Project Period: "]
["Study Number",null,null,null,null,null,"Coordinator: "]
["IND/IDE#",null,null,null,null,null,"IDC RATE: ",null,0.35,"Non-negotiable for industry sponsors"]
["EXPECTED # OF PATIENTS:",null,null,null,null,null,"Hospital IDC RATE: ",null,null,"Non-negotiable for industry sponsors"]
[]
["SPONSORED PROJECTS ACCOUNT BREAKDOWN"]
["PERSONNEL COSTS"]
["Position",null,"Name",null,null,null,"% Effort","Salary Requested 500001",null,"Fringe Requested 510000",null,"Total"]
["PI",null,null,null,null,null,{"$f":"'EFFORT BASED COST'!AH70*Summary!D11","v":0}]
["Clinical Research Coordintor",null,null,null,null,null,{"$f":"'EFFORT BASED COST'!AG70*Summary!D11","v":0},null,null,null,null,null,null,null," "]
["Co-Investigator ",null,null,null,null,null,{"$f":"'EFFORT BASED COST'!AJ70*Summary!D11","v":0}]
["Subtotal Personnel Costs",null,null,null,null,null,null,0,null,{"$f":"H19*0.41","v":0},null,{"$f":"H19+J19","v":0}]
["OPERATING SERVICES COSTS"]
[540000,null,"Supplies",null,null,null,0]
[520000,null,"Travel",null,null,null,0]
[530000,null,"Consultants",null,null,null,0]
[560000,null,"Other",null,null,null,0]
[570000,null,"Equipment",null,null,null,0]
[530000,null,"Operating Services",null,null,null,0]
[550000,null,"Subcontract [Hospital/Clinic]",null,null,null,0]
[550000,null,"Subcontract [Hospital/Clinic]",null,null,null,0,null,null,null,null,null,null,null,null,null,null,null,null," "]
[null,null,"Subtotal Operating Services",null,null,null,{"$f":"SUM(G21:L28)","v":0}]
["LSUHSC TOTAL"]
[null,null,"Modified TOTAL Direct Costs",null,null,null,{"$f":"L19+G29","v":0}]
[510000,null,"LSUHSC Start-Up Fee",null,null,null,0,null,null,null,null,null,null,null,null,null," "]
[590000,null,"TOTAL Indirect Costs",null,null,null,{"$f":"(G31+G32)*I10","v":0}]
[530000,null,"IRB Service Charge",null,null,null,0]
[530000,null,"Patient Incentives",null,null,null,0]
[null,null,"TOTAL ANTICIPATED STUDY COSTS",null,null,null,{"$f":"G31+G32+G33+G34+G35","v":0}]
["REVENUE FROM SPONSOR"]
[null,null,"Subtotal Per Patient Cost",null,null,null,0]
[null,null,"Site Start-Up Fee",null,null,null,0]
[null,null,"LSUHSC IRB Fee",null,null,null,0]
[null,null,"Study Closeout Fee",null,null,null,0]
[null,null,"ANTICIPATED FUNDING BY SPONSOR ",null,null,null,{"$f":"(G38*D11)+G39+G40+G41","v":0}]
[null,null,"ANTICIPATED STUDY SURPLUS/DEFICIT ",null,null,null,{"$f":"G42-G36","v":0}]
["COMMENTS:"]
[]
[]
[]
[]
[]
["As Principal Investigator, I have reviewed this budget and have determined items billable to research or standard of care as noted. "]
["PI Signature: ","X",null,null,null,null,null,null,"Date:"]
["Coverage Analysis Completed By: ",null,null,null,null,null,null,null,"Date:"]
["Budget Completed By:",null,null,null,null,null,null,null,"Date:"]
[]
[]
[null,null,null,null,null,null,null,null,null,"VERSION 5/18/2022"]

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[]
["STARTUP COSTS"]
["Paid upon contract execution and non-refundable."]
[null,null,null,null,null,"Fee"]
["Administrative Start-Up Fee",null,null,null,null,10800]
["Hospital Start-Up Fee"]
["Initial IRB Review - Full Board",null,null,null,null,2500]
["Initial IRB Review - Commercial IRB",null,null,null,null,2000]
[]
["INVOICEABLE COSTS"]
["Invoiced per occurrence"]
[null,null,null,null,null,"Fee"]
["Protocol Amendment with Consent Changes",null,null,null,null,500]
["Protocol Amendment without Consent Changes",null,null,null,null,250]
["Budget or Contract Amendment",null,null,null,null,450]
["Monitoring Visit (Remote or On Site), Half Day",null,null,null,null,500]
["Monitoring Visit (Remote or On Site), Full Day",null,null,null,null,1000]
["Monitor Change Fee",null,null,null,null,500]
["Sponsor-Directed Audit, per day",null,null,null,null,1000]
["FDA-Directed Audit, per day",null,null,null,null,2000]
["SAE Reporting, per event",null,null,null,null,250]
["Document Storage Fee",null,null,null,null,750]
["Administrative Close-Out and Visit ",null,null,null,null,1000]
["Reconsent",null,null,null,null,100]
["Lab Set-Up/Specimen Storage Fee",null,null,null,null,750]
["LSUHN Clinical Room Rate, per visit ",null,null,null,null,130]
[]
["Study Staff Non-CPT Coded Service Rate"]
["Invoiced per occurrence"]
[null,null,null,null,null,"Fee"]
["Principal Investigator",null,null,null,null,"Varies"]
["Clinical Research Nurse Coordinator, per hour",null,null,null,null,100]
["Clinical Research Coordinator, per hour",null,null,null,null,75]

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["Staff "]
["PI"]
["Study Coord"]
["Pharmacist"]
["Co Investigator"]
["Hospital Personnel"]

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[]
[]
[]
[]
["EFFORT-BASED COSTS"]
["For each activity, select the person responsible from the drop down menu. Enter the amount of time (in hours) to conduct that activity at each visit; if  you have more than 13 visits, change the end of care visit to Visit 14 and scroll to the right to use additional columns."]
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["Total Number of Staff Hours:  ",null,null,null,{"$f":"SUM(E9:E68)","v":0},{"$f":"SUM(F9:F68)","v":0},{"$f":"SUM(G9:G68)","v":0},{"$f":"SUM(H9:H68)","v":0},{"$f":"SUM(I9:I68)","v":0},{"$f":"SUM(J9:J68)","v":0},{"$f":"SUM(K9:K68)","v":0},{"$f":"SUM(L9:L68)","v":0},{"$f":"SUM(M9:M68)","v":0},{"$f":"SUM(N9:N68)","v":0},{"$f":"SUM(O9:O68)","v":0},{"$f":"SUM(P9:P68)","v":0},{"$f":"SUM(Q9:Q68)","v":0},{"$f":"SUM(R9:R68)","v":0},{"$f":"SUM(S9:S68)","v":0},{"$f":"SUM(T9:T68)","v":0},{"$f":"SUM(U9:U68)","v":0},{"$f":"SUM(V9:V68)","v":0},{"$f":"SUM(W9:W68)","v":0},{"$f":"SUM(X9:X68)","v":0},{"$f":"SUM(Y9:Y68)","v":0},{"$f":"SUM(Z9:Z68)","v":0},{"$f":"SUM(AA9:AA68)","v":0},{"$f":"SUM(AB9:AB68)","v":0},{"$f":"SUM(AC9:AC68)","v":0},{"$f":"SUM(AD9:AD68)","v":0},{"$f":"SUM(AE9:AE68)","v":0},{"$f":"SUM(AF9:AF68)","v":0},{"$f":"SUM(AG9:AG68)","v":0},{"$f":"SUM(AH9:AH68)","v":0},{"$f":"SUM(AI9:AI68)","v":0},{"$f":"SUM(AJ9:AJ68)","v":0}]
["Effort Cost per Visit",null,null,null,{"$f":"E144","v":0},{"$f":"F144","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,{"$f":"SUM(AG69/2080)","v":0},{"$f":"SUM(AH69/2080)","v":0},{"$f":"SUM(AI69/2080)","v":0},{"$f":"SUM(AJ69/2080)","v":0}]
[]
[]
["SALARIES"]
[null,"Hourly Rate",null," "]
["PI",200]
["Study Coordinator",75]
["Co-Investigator",200]
["Hospital Staff",0]
[]
[]
["PER PATIENT RESEARCH COSTS"]
["EFFORT-BASED COSTS",null,null,"Staff Responsible - SC or PI","Timeline",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TOTAL"]
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["Subtotal effort-based costs:",null,null,null,{"$f":"SUM(E84:E143)","v":0},{"$f":"SUM(F84:F143)","v":0},0,0,0,0,0,0,0,0,{"$f":"SUM(O84:O143)","v":0},{"$f":"SUM(P84:P143)","v":0},{"$f":"SUM(Q84:Q143)","v":0},{"$f":"SUM(R84:R143)","v":0},{"$f":"SUM(S84:S143)","v":0},{"$f":"SUM(T84:T143)","v":0},{"$f":"SUM(U84:U143)","v":0},{"$f":"SUM(V84:V143)","v":0},{"$f":"SUM(W84:W143)","v":0},{"$f":"SUM(X84:X143)","v":0},{"$f":"SUM(Y84:Y143)","v":0},{"$f":"SUM(Z84:Z143)","v":0},{"$f":"SUM(AA84:AA143)","v":0},{"$f":"SUM(AB84:AB143)","v":0},{"$f":"SUM(AC84:AC143)","v":0},{"$f":"SUM(AD84:AD143)","v":0},{"$f":"SUM(AE84:AE143)","v":0},{"$f":"SUM(AF84:AF143)","v":0},{"$f":"SUM(AG84:AG143)","v":0}]

{"sheet":"EXP BASED COST","index":4,"n_rows":20,"n_cols":32,"rows_kept":20,"cut":false,"hidden":false,"merged":[[0,0,0,31],[1,0,1,31],[19,0,19,2],[2,3,2,30],[2,31,3,31],[2,2,3,2],[2,1,3,1],[2,0,3,0]]}
["EXPENSE-BASED COSTS"]
["For each Item or Procedure, enter the appropriate CPT code. Enter the amount (in dollars) to conduct that item or procedure at each visit. "]
["Category","EXPENSE-BASED Item or Procedure","CPT Code","Timeline",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Total"]
[null,null,null,{"$f":"'EFFORT BASED COST'!E8","v":"Baseline/ Screening"},{"$f":"'EFFORT BASED COST'!F8","v":"Visit 1"},{"$f":"'EFFORT BASED COST'!G8","v":"Visit 2"},{"$f":"'EFFORT BASED COST'!H8","v":"Visit 3"},{"$f":"'EFFORT BASED COST'!I8","v":"Visit 4"},{"$f":"'EFFORT BASED COST'!J8","v":"Visit 5"},{"$f":"'EFFORT BASED COST'!K8","v":"Visit 6"},{"$f":"'EFFORT BASED COST'!L8","v":"Visit 7"},{"$f":"'EFFORT BASED COST'!M8","v":"Visit 8"},{"$f":"'EFFORT BASED COST'!N8","v":"Visit 9"},{"$f":"'EFFORT BASED COST'!O8","v":"Visit 10"},{"$f":"'EFFORT BASED COST'!P8","v":"Visit 11"},{"$f":"'EFFORT BASED COST'!Q8","v":"Visit 12"},{"$f":"'EFFORT BASED COST'!R8","v":"Visit 13"},{"$f":"'EFFORT BASED COST'!S8","v":"Visit 14"},{"$f":"'EFFORT BASED COST'!T8","v":"Visit 15"},{"$f":"'EFFORT BASED COST'!U8","v":"Visit 16"},{"$f":"'EFFORT BASED COST'!V8","v":"Visit 17"},{"$f":"'EFFORT BASED COST'!W8","v":"Visit 18"},{"$f":"'EFFORT BASED COST'!X8","v":"Visit 19"},{"$f":"'EFFORT BASED COST'!Y8","v":"Visit 20"},{"$f":"'EFFORT BASED COST'!Z8","v":"Visit 21"},{"$f":"'EFFORT BASED COST'!AA8","v":"Visit 22"},{"$f":"'EFFORT BASED COST'!AB8","v":"Visit 23"},{"$f":"'EFFORT BASED COST'!AC8","v":"Visit 24"},{"$f":"'EFFORT BASED COST'!AD8","v":"Visit 25"},{"$f":"'EFFORT BASED COST'!AE8","v":"Visit 26"},{"$f":"'EFFORT BASED COST'!AF8","v":"Closeout Visit"}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(D5:AE5)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
["Subtotal Expense-Based Cost:",null,null,{"$f":"SUM(D5:D19)","v":0},{"$f":"SUM(E5:E19)","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,{"$f":"SUM(AF5:AF19)","v":0}]

{"sheet":"Document Storage Worksheet","index":5,"n_rows":25,"n_cols":9,"rows_kept":25,"cut":false,"hidden":true,"merged":[]}
["DOCUMENT STORAGE","2011 Rates","2012 Rates","2013 Rates","2014 Rates","2015 Rates","2016 Rates","2017 Rates","2018 Rates"]
["(change only values in boxes)"]
[null,"RecordMax"]
["Box",2.75]
["Accession",1.95]
["Destruction",3.5]
["Monthly box rate",0.2]
[]
["Number of boxes",10]
["Number of years",10]
[]
["Number of months",{"$f":"B10*12","v":120}]
["Montly storage",{"$f":"B7*B9","v":2}]
["Total storage",{"$f":"B13*B12","v":240}]
["One time fees",{"$f":"B4*B9","v":27.5}]
["Box up Study Records (3 hrs)",{"$f":"#REF!*3","v":{"$error":"#REF!"}}]
[]
["TOTAL DOCUMENT",{"$f":"SUM(B13:B16)","v":{"$error":"#REF!"}}]
["Per year",{"$f":"B18/10","v":{"$error":"#REF!"}}]
[]
["Rounded to nearest $50",{"$f":"ROUNDUP(B18,10)","v":{"$error":"#REF!"}}]
["(for budget purposes)",{"$f":"CEILING(B21, 50)","v":{"$error":"#REF!"}}]
[]
[]
["Annual rent increase of 3%",null,{"$f":"B22*1.03","v":{"$error":"#REF!"}},{"$f":"C25*1.03","v":{"$error":"#REF!"}},{"$f":"D25*1.03","v":{"$error":"#REF!"}},{"$error":"#REF!"},{"$error":"#REF!"},{"$error":"#REF!"},{"$error":"#REF!"}]