APPENDIX-C.1-Technical and Management Proposal Model

<PRIME ORGANIZATION LOGO (optional)>

Proposal Title

Prime Organization Name

Organization Type
Choose all that apply:
☐ For-Profit ☐ Non-profit ☐ Academia
SAM.gov Universal Entity Identifier (UEI)

Contact Address - State

Proposer’s Internal Reference Number, if any

Key Personnel/Staff
Name:
Email:
Organization:
(Repeat, as necessary)
Prime Technical Point of Contact (POC)
Name:
Mailing Address:
Telephone:
Email:
Prime Administrative POC (APOC)
Name:
Mailing Address:
Telephone:
Email:
Award Instrument Requested
Other Transaction
Animal Subjects
☐ Yes ☐ No
Human Subjects
☐ Yes ☐ No
Total Funds Requested From ARPA-H (including all phases) Total: $
Resource Sharing (if applicable)
Place(s) of Performance

Date of Proposal Submission

Proposal’s Validity Period
(minimum 120 days)

SUB-AWARDEE AND CONSULTANT

TEAM MEMBERS

(Add rows as necessary)

Organization Name:

Technical POC
Name:
Telephone:
Email:
Organization Type:
Choose all that apply:
☐ For-Profit ☐ Non-profit ☐ Academia
Organization Name:

Technical POC
Name:
Telephone:
Email:
Organization Type:
Choose all that apply:
☐ For-Profit ☐ Non-profit ☐ Academia
Organization Name:

Technical POC
Name:
Telephone:
Email:
Organization Type:
Choose all that apply:
☐ For-Profit ☐ Non-profit ☐ Academia
Organization Name:

Technical POC
Name:
Telephone:
Email:
Organization Type:
Choose all that apply:
☐ For-Profit ☐ Non-profit ☐ Academia

TOC \o "1-3" \h \z \u 1.Proposal Summary PAGEREF _Toc216876120 \h 4 2.Goals and Impact PAGEREF _Toc216876121 \h 5
3.Gant Chart Timeline PAGEREF _Toc216876122 \h 5
4.Technical Plan PAGEREF _Toc216876123 \h 5
5.Risk Mitigation/Contingency Plans and Alternative Approaches PAGEREF _Toc216876124 \h 5 6.Commercialization Strategy Narrative PAGEREF _Toc216876125 \h 5 7.Capabilities/Management Plan PAGEREF _Toc216876126 \h 7 8.Software Component Technical Plan – Not Included In The Page Limit PAGEREF _Toc216876127 \h 7 9.Biographical Information – Not Included In The Page Limit PAGEREF _Toc216876128 \h 7 10.References Cited – Not Included in The Page Limit PAGEREF _Toc216876129 \h 7 11.Letters of Support– Not Included In the Page Limit PAGEREF _Toc216876130 \h 7

Proposal Summary

OVERVIEW

Provide a synopsis of the proposed project, including answers to the following questions: What is the proposed work attempting to accomplish or do? How is the proposed work leading to improved health outcomes or improvements in the reliability of health systems?