Extramural/ Renewal Applicants

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
Loan Repayment Programs
Instructions for Application Package: NIH 2674
This document provides guidance for responding to items on the 19 forms that compose the NIH
2674 application package. More detailed instructions are contained on each of the online forms.
If you have any questions on the application, please refer to the Website (www.lrp.nih.gov) or call
the NIH LRP Help Line at 866 849-4047.
You must complete all required forms online. Incomplete applications will not be reviewed.
The Office of Loan Repayment and Scholarship (OLRS), located in the Office of the Director
(OD), National Institutes of Health (NIH) is responsible for the administration of payments and
oversight of the application process for the following Loan Repayment Programs: Pediatric
Research; Clinical Research; Health Disparities Research; Clinical Researchers from
Disadvantaged Backgrounds; and Contraception and Infertility Research. These programs are
administered in accordance with Sections 485G, 487B, 487E, 487F and 487G of the Public
Health Service Act (42 USC 287c-33, 288-2, 288-5, 288-5a, and 288-6).
2674-1 Applicant Information
Please provide us with your contact, employment, educational, other service obligation, federal
affiliations, and other information. You are required to attach a copy of your Biosketch. You may
voluntarily provide us with information on your Gender/Race/National Origin/Disability Status.
This online form is required for all applicants.
2674-2 Personal Statement
The purpose of this online form is for you to describe your previous research training experience,
short-term academic and research objectives, long-term career objectives and plan to achieve
these objectives. This information is used by NIH to evaluate your commitment to a career in
research and the appropriateness of previous training and experience as preparation for a career
in clinical research. This online form is required for all applicants.
2674-3 Recommendations
Please use this online form to identify professional references that will provide a recommendation
for you. The application process requires each applicant to obtain at least three (3)
recommendations; however, you may list up to five (5). All completed recommendations are
reviewed. This online form is required for all applicants except for Intramural Renewal applicants.
2674-4 Loan Information Form
This online form identifies your outstanding educational debt. All New LRP applicants are
required to complete one or more forms providing detailed information on your qualifying
educational loans. If your application is selected for funding, you will be required to submit copies

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of your Promissory Note and a current Loan Statement for each loan identified on the Loan
Information form(s). This online form is required for all New applicants.
2674-5 IC Recommendation for LRP Funding
This online form is completed by the NIH Loan Repayment Coordinator for all Intramural
applicants. It provides information which is used to verify eligibility for the program. It is required
for all Intramural applicants.
2674-5 Research Activities
Please upload a document outlining your specific research project during the term of the LRP
contract. You must describe the research activities you will pursue over the next contract period,
your specific responsibilities, and your role in the research. If you are working with a Research
Supervisor or Principal Investigator, please provide us with their name and email address so they
can complete a recommendation and an assessment of research activities form on your behalf.
If you are an Independent researcher and do not have a Research Supervisor or Principal
Investigator, provide us with a document outlining your Research Environment and your Career
Development Plan. This online form is required for all applicants.
2674-6 Assessment of Research Activities
This online form is completed by your Research Supervisor or Principal Investigator, if you have
designated one. They will provide their Biosketch, a document outlining the Research
Environment, your Training and Mentoring Plan, and may upload the biosketch of the individual
responsible for your mentoring and training. This online form is required for all applications.
2674-7 Research Accomplishments
This online form allows a renewal applicant to document the research accomplishments achieved
during the prior contract period. If you have recently changed your research project or research
supervisor, provide us with contact information of the mentor who can best speak to your past
accomplishments. This online form is only required for Renewal applicants.
2674-8 Certifications for Online Applications
Please print, review, and sign this online form where indicated and fax it to 866-849-4046. This
will certify to the accuracy of the information you provided in your application, allow NIH to obtain
information on your loans, and confirm the confidentiality of the recommendations. This online
form is required for all applicants.
2674-9 Institutional Contact
Please provide us with the name and email address of the institutional representative that will
certify to the required support from your employer over the term of the contract. The official
providing this information should be someone authorized to reply for the organization. If you are
not certain whom to name, please consult with your Research Supervisor or Principal
Investigator. This online form is required for all applicants.

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2674-10 Disadvantaged Background Documentation
Applicants to the Clinical Research for Individuals from Disadvantaged Background LRP should
complete this form. To meet the low-income requirement you must demonstrate your
disadvantaged status by submitting (1) a written statement from your former school(s) where you
qualified for Federal disadvantaged assistance, (2) verification of receipt of loans from either the
Health Professions Student Loans (HPSL) or Loans for Disadvantaged Student Program, or (3)
verification of a scholarship from the U.S. Department of Health and Human Services under the
Scholarship for Individuals with Exceptional Financial Need.
2674-11 Contract
You are required to read, sign and return the contract. The signed contract is required for all
applicants.
2674-12 Recommendation
This online form will be completed by the professional references listed on Form 2674-3.
References should complete contact information, provide ratings regarding the applicant’s
research capabilities, and provide an overall assessment of the applicant. This online form is
required for all applicants.
2674-13 Assessment of Research Accomplishments
This online form will be completed by the Research Supervisor or Principal Investigator identified
on Form 2674-6. Please complete contact information, review the attached research
accomplishments document provided by the applicant, and provide an assessment of the
applicant’s research accomplishments. This online form is required for Renewal applicants only.
2674-15 Apply Here
Please use this online form to obtain your login ID and password and to indicate which NIH LRP
you are applying for. The email address you provide will be used to contact you during the
application cycle. NIH needs your SSN to verify your identity, determine your eligibility for loan
repayment assistance and the amount of assistance, and to keep track of the Federal funds you
receive. NIH also uses your SSN for loan repayment and servicing purposes. See Privacy Act
information in this package. Identify if you are applying to the Extramural Program (for Non-NIH
researchers) or Intramural Program (for NIH researchers); which LRP you are applying for; if you
are a New Applicant or Renewal Applicant; and if you will be identifying a Research Supervisor.
If you are an Intramural applicant, you will need to provide your title and the hiring NIH institute or
center. This online form is required for all applicants.
2674-16 Institutional Information
This online form will be completed by the institutional representative identified on Form 2674-10.
Please complete contact information, provide the applicant’s salary and certify the source of
funding and that your institution will provide the necessary support for the applicant to conduct
research for the duration of the contract. For New Applicants, the initial period will be for two
years beginning in July. For Renewal Applicants, certify to one (1) or two (2) years of additional
support for the applicant. This certification is required for all Extramural applicants.

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2674-17 Loan Information Form
This form provides NIH with current information on the specified loan and is completed by the
applicant’s lender.
2674-18 Citizenship Information
The NIH LRP is open to U.S. Citizens and U. S. Permanent Residents. Please complete this
online form verifying your citizenship status and submit documentation necessary to establish
your citizenship status. This online form is required for all New Extramural applicants.
2674-19 Funding Information
Please use this online form to list the top three (3) non-profit funding sources supporting your
research activities over the term of the LRP contract. At least one non-profit or NIH funding
source must be identified. This online form is required for all Extramural applicants.

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