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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
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 (PDFMS Word)
March 2020
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 (PDFMS Word)
There is no electronic submission system for fellowship activation notices.
 
Individual Fellowship form and instructions (PDFMS Word) 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 (PDFMS Word)

April 2020
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   (PDFMS Word)
There is no electronic system for submission of the Payback Agreement.
Payback Agreement instructions and form   (PDFMS Word) December 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.

Annual Payback Activities Certification instruction and form   (PDFMS Word)
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   (PDFMS Word)
  • There is no electronic system for submission of the Annual Payback Activities Certification. 
April 2020
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