Ruth L. Kirschstein National Research Service Award Individual Fellowship Application

Form Name: 
Ruth L. Kirschstein National Research Service Award Individual Fellowship Application
Form Description: 

Use only for a change of sponsoring institution applications.
 

Form Order Number: 
2
Main Category: 
Submit Change of Institution Request
Fellowships and Training
Subordinate Category: 
None
Form Date Posted: 
Friday, March 25, 2016
Form Format: 

Ruth L. Kirschstein National Research Service Award Individual Fellowship Application

Form Number: 
PHS 416-1
Additional Information: 
May be submitted electronically. Follow instructions in funding opportunity announcement.
Form Updated Date: 
March, 2016

Official Statement Relinquishing Interests and Rights in a PHS Research Grant

Form Name: 
Official Statement Relinquishing Interests and Rights in a PHS Research Grant
Form Description: 

Used as the official statement relinquishing interests and rights in a PHS research grant.

Form Order Number: 
1
Main Category: 
Submit Change of Institution Request
Post Awards
Subordinate Category: 
None
Form Date Posted: 
Monday, June 1, 2015
Form Format: 

Official Statement Relinquishing Interests and Rights in a PHS Research Grant

Form File Upload: 
Form Number: 
PHS 3734 
How to Access: 
View the form to see what information we request.  (PDF, Word)
Additional Information: 

The signing official should submit the information required on the relinquishing statement through the eRA Commons. 

Learn more about submitting relinquishing statements in eRA Commons. 

Form Updated Date: 
October, 2017

Annual Payback Activities Certification (APAC)

Form Name: 
Annual Payback Activities Certification (APAC)
Form Description: 

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.

Form Order Number: 
5
Main Category: 
Manage Fellowship
Fellowships and Training
Subordinate Category: 
None
Form Date Posted: 
Monday, June 1, 2015
Form Format: 

Annual Payback Activities Certification (APAC) 

Form File Upload: 
Form Number: 
PHS 6031-1  
How to Access: 
Annual Payback Activities Certification instruction and form   (PDF, MS Word)
Additional Information: 
There is no electronic system for submission of the Annual Payback Activities Certification. 
Form Updated Date: 
October, 2017

Payback Agreement

Form Name: 
Payback Agreement
Form Description: 

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

Form Order Number: 
4
Main Category: 
Manage Fellowship
Fellowships and Training
Subordinate Category: 
None
Form Date Posted: 
Monday, June 1, 2015
Form Format: 

Payback Agreement

Form File Upload: 
Form Number: 
PHS 6031 
How to Access: 
Payback Agreement instructions and form   (PDF, MS Word)
Additional Information: 
There is no electronic system for submission of the Payback Agreement. 
Form Updated Date: 
August, 2017

Termination Notice

Form Name: 
Termination Notice
Form Description: 

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.

Form Order Number: 
3
Main Category: 
Manage Fellowship
Fellowships and Training
Subordinate Category: 
None
Form Date Posted: 
Friday, January 1, 2016
Form Format: 

Termination Notice 

Form File Upload: 
Form Number: 
PHS 416-7  
Additional Information: 
The use of the eRA Commons xTrain system is mandatory to electronically prepare Termination Notices.  
Log onto the eRA Commons to access xTrain.
Form Updated Date: 
August, 2017

Individual Fellowship Activation Notice

Form Name: 
Individual Fellowship Activation Notice (PHS 416-5)
Form Description: 

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

Form Order Number: 
2
Main Category: 
Manage Fellowship
Fellowships and Training
Subordinate Category: 
None
Form Date Posted: 
Monday, June 1, 2015
Form Format: 

Individual Fellowship Activation Notice 

Form File Upload: 
Form Number: 
PHS 416-5  (PDF - 39 KB)     
How to Access: 
Individual Fellowship form and instructions (PDF, MS Word)
 
Additional Information: 
There is no electronic submission system for fellowship activation notices.
Form Updated Date: 
June, 2017

Statement of Appointment

Form Name: 
Statement of Appointment
Form Description: 

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.

Form Order Number: 
1
Main Category: 
Manage Fellowship
Fellowships and Training
Subordinate Category: 
None
Form Date Posted: 
Saturday, February 13, 2016
Form Format: 

Statement of Appointment 

Form File Upload: 
Form Number: 
PHS 2271
How to Access: 
Statement of Appointment form and instructions (PDF, MS Word)
 
Additional Information: 
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. 
Form Updated Date: 
October, 2017

NIH Federal Financial Report Supplemental Instructions

Form Name: 
NIH Federal Financial Report Supplemental Instructions
Form Description: 

NIH’s Federal Financial Report Supplemental Instructions provide
NIH grantees with instructions they should follow in conjunction with the standard FFR Instructions

Form Order Number: 
2
Main Category: 
Report on a Grant Award
Subordinate Category: 
Federal Financial Report (FFR)
Form Date Posted: 
Saturday, October 1, 2011
Form Format: 

NIH Federal Financial Report Supplemental Instructions

Form File Upload: 

Federal Financial Report

Form Name: 
Federal Financial Report
Form Description: 

Form used to submit financial information about individual grant awards. Report the cash transaction data (items 10a-c) on a quarterly basis directly to the Payment Management System (PMS).

Form Order Number: 
1
Main Category: 
Report on a Grant Award
Post Awards
Subordinate Category: 
None
Federal Financial Report (FFR)
Form Date Posted: 
Saturday, October 1, 2011
Form Format: 

Federal Financial Report 

Form File Upload: 
Form instructions Description : 
FFR instructions (PDF) should be used in combination with the NIH Federal Financial Report supplemental instructions (MS WORD).
Form Number: 
SF 425
Additional Information: 
Report the FFR expenditure data (items 10d-13e) via the eRA Commons FFR/FSR module. You need to have the FSR role in eRA Commons to access the module.  
See the eRA Submit Federal Financial Report page for details
Guide notices announcing use of FFR: NOT-OD-10-038 and NOT-OD-11-017.
Form Updated Date: 
August, 2017

Final Invention Statement

Form Name: 
Final Invention Statement
Form Description: 

Instructions and form for submitting the Financial Invention Statement.Final Invention Statements must be submitted electronically through the eRA Commons. Although a principal investigator can created the Final Invention Statement, only a signing official can submit it to the agency.

Form Order Number: 
1
Main Category: 
Report on a Grant Award
Post Awards
Subordinate Category: 
None
Invention Reports
Form Date Posted: 
Tuesday, June 30, 2015
Form Format: 

Final Invention Statement

Form File Upload: 
Form instructions Description : 
PDFWord  
Form Number: 
HHS 568  
How to Access: 
Use form in eRA Commons. View of form fields available with instructions. 
 
Additional Information: 
Final Invention Statements must be submitted electronically through the eRA Commons. Although a principal investigator can created the Final Invention Statement, only a signing official can submit it to the agency.
Learn more about submitting your Final Invention Statement through the eRA Commons.
Form Updated Date: 
October, 2017

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