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 Date Posted
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.

Statement of Appointment form and instructions (PDF, MS Word)
 
The use of the eRA Commons xTrain system is mandatory to electronically prepare and submit PHS 2271 Statement of Appointment forms.  
Log onto the eRA Commons to access xTrain. 
February 2016 February 2016
Individual Fellowship Activation Notice (PHS 416-5) PHS 416-5  (PDF - 39 KB)     

All fellows must complete this form for the first year of their fellowship, indicating their start date under the fellowship and other requested information.

Individual Fellowship form and instructions (PDF, MS Word)
 
There is no electronic submission system for fellowship activation notices. June 2017 June 2015
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.

Termination Notice form and instruction (PDF, MS Word)
 
The use of the eRA Commons xTrain system is mandatory to electronically prepare Termination Notices.  
Log onto the eRA Commons to access xTrain.
August 2017 January 2016
Payback Agreement PHS 6031 

To be completed by trainees and fellows in their first 12 months of post-doctoral support.

Payback Agreement instructions and form   (PDF, MS Word) There is no electronic system for submission of the Payback Agreement.  August 2017 June 2015
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.

Annual Payback Activities Certification instruction and form   (PDF, MS Word) There is no electronic system for submission of the Annual Payback Activities Certification.  August 2017 June 2015