0MB Number: 4040-0001 Exnlratlon Date: 10/3112019 APPLICATION FOR FEOERAL ASSISTANCE SF 424 (R&R) 3. DATE RECEIVED BY STATE II State Application Identifier 1. TYPE OF SUBMISSION D Pre-application cg] Application D Changed/Corrected Application 2. DATE SUBMITTED Applicant Identifier II I 4. a. Federal Identifier b. Agency Routing Identifier c. Previous Grants.gov 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 8. TYPE OF APPLICATION: cg] New D Resubmission D Renewal D Continuation Revision If Revision, mark appropriate box(es). DA. Increase Award DB. Decrease Awardc. Increase Duration DD. Decrease Duratton DE. Other (specify):I I 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: ~,====...