Manage Fellows and Trainees

A number of forms are used to manage the appointment, termination, and payback activities related to training and fellowship grants.

Form Name	Form Number	Description	How to Access	Instructions	Additional Information	Updated Date
Payback Agreement	PHS 6031	To be completed by trainees and fellows in their first 12 months of post-doctoral support.	There is no electronic system for submission of the Payback Agreement.	Payback Agreement instructions and form Payback Agreement instructions and form	See NIH Grants Policy Statement, Section 11.3.13.2 Payback Agreement (Form PHS 6031)	December 2020
Individual Fellowship Activation Notice	PHS 416-5	All fellows must complete this form for the first year of their fellowship, indicating their start date under the fellowship and other requested information.	There is no electronic submission system for fellowship activation notices.	Individual Fellowship form and instructions Individual Fellowship form and instructions	See NIH Grants Policy Statement, Section 11.2.11.1 Activation Notice	April 2020
Termination Notice	PHS 416-7	Used to document the termination of appointments to non-NRSA individual and institutional research training programs. The Termination Notice serves as the official record of your training.	Must use the eRA Commons xTrain system to prepare Termination Notices.	For reference only Termination Notice form and instruction Termination Notice form and instruction	See NIH Grants Policy Statement, Section 11.3.13.3 Termination Notice (Form PHS 416-7) xTrain Help & Tutorials	April 2020
Annual Payback Activities Certification (APAC)	PHS 6031-1	The Annual Payback Activities Certification form is the formal communication between former Kirschstein-NRSA recipients and the PHS regarding the status of payback activities. The certification form must be signed and returned to the NRSA Payback Service center. See form instruction for details.	There is no electronic system for submission of the Annual Payback Activities Certification. NIH Grants Policy Statement, Section 11.4.4 Certification of Payback Activities	Annual Payback Activities Certification instruction and form Annual Payback Activities Certification instruction and form		April 2020
Statement of Appointment	PHS 2271	Use for each appointment of an individual as a trainee under a Kirschstein-NRSA or other institutional training grant. Also use for appointments on career development awards.	Must use the eRA Commons xTrain system to prepare and submit PHS 2271 Statement of Appointment forms.	For reference only Statement of Appointment form and instructions	See NIH Grants Policy Statement, Section 11.3.13.1 Statement of Appointment (Form PHS 2271) xTrain Help & Tutorials	March 2020

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