Notice Number: NOT-OD-06-018

Key Dates
Release Date: December 9, 2005

Issued by
National Institutes of Health (NIH), (http://www.nih.gov/)

NIH announces the availability of four revised (rev.10/05) forms associated with the Kirschstein-NRSA process:

1) PHS 416-5 (Activation Notice)
2) PHS 416-7 (Termination Notice)
3) PHS 6031 (Payback Agreement)
4) PHS 6031-1(Annual Payback Activities Certification)

The newly revised forms and instructions are available at http://grants.nih.gov/grants/forms.htm. The forms continue to be provided in two electronic formats—MS Word and PDF-fillable using Adobe Acrobat Reader Software. Free Adobe Software may be accessed at http://www.adobe.com/products/acrobat/readstep.html.

Notable Changes to the Revised Forms (rev.10/05) and Effective Dates:

PHS 416-5 (Activation Notice)

• Signature blocks: Fields have been added for e-mails addresses for the Fellow, Sponsor, and Business Official.
• Submission Requirements: The submission requirement has been changed to submit only the signed, original document. An additional copy is no longer required.

Effective Date: The 10/05 version is available and required for immediate use. Any supply of the previous version should no longer be used.

PHS 416-7 (Termination Notice)

• Trainees and fellows are now requested to provide only the last four digits of the Social Security Number (SSN). While providing this information remains voluntary, it is hoped that by limiting the data to only the last four digits, individuals will be more receptive to providing it. This vital information continues to provide the agency with accurate identification of individuals and for management of PHS grant programs.
• E-mail address for the trainee/fellow has been added as part of the requested contact information.
• (Item 9) Post-Award Information – This section has been modified to add more definitive data collection of post award activities.
• A field has been added in Item 11 to capture participating in any NIH Loan Repayment Program. Note this field is necessary because participation in a NIH loan Repayment Program requires deferral of any payback obligation.
• Instructional text has been updated for clarity.

Effective Date: The 10/05 version is available and required for immediate use. Any supply of the previous version should no longer be used.

PHS 6031 (Payback Agreement)

• A field has been added for the entire nine-digit SSN. This is required because of the potential for the individual signing the form to have a financial payback obligation. The entire SSN is vital for tracking purposes for these individuals.
• Added field for e-mail addresses for all required signatures.
• Instructional text has been updated for clarity.

Effective Date: The 10/05 version is available and required for immediate use. Any supply of the previous version should no longer be used.

PHS 6031-1 (Annual Payback Activities Certification)

• Data field and all instructional references for “alternative service” have been eliminated as this is no longer applicable.
• Instructional text has been updated for clarity and to reflect current policy.

Effective Date: The 10/05 version is available and required for immediate use. Any supply of the previous version should no longer be used.

General inquires about the changes to these forms may be directed to:

Division of Grants Policy
Office of Policy for Extramural Research Administration
National Institutes of Health
6705 Rockledge Drive, Suite 350
Bethesda, MD 20892
Telephone: (301) 435-0938
FAX: (301) 435-3059
Email: GrantsPolicy@od.nih.gov

Weekly TOC for this Announcement
NIH Funding Opportunities and Notices

	Office of Extramural Research (OER)			National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, Maryland 20892			Department of Health and Human Services (HHS)
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