| Attachment 15 - eRA Commons Person Profile Data | |||
| Currently Collected on OMB Cleared Forms | |||
| OMB Clearance # 0925-0001 | |||
| Field Name | Req Opt |
Type of Field | LOV or Notes |
| Name and ID | |||
| Name Prefix | O | Text | |
| First Name | R | Text | |
| Middle Name or Initial | O | Text | |
| Last Name | R | Text | |
| Name Suffix | O | Text | |
| eRA Email | R | Text | |
| ORCHID ID | O | Text | Will be a data feed from another system |
| IDENTIFICATION | |||
| DOB (Include DNWTP option) |
R | Date | DNWTP check provided |
| SSN (full or last 4) | O | Text | |
| CITIZENSHIP STATUS | |||
| Citizenship Country | R | LOV | Country List |
| Status in the United States | R | Radio Buttons | US Citizen or Non-citizen National Permanent Resident of US Non-U.S. Citizen w/a temporary U.S. Visa Non-U.S. Citzen--Not Residing in the U.S. |
| DEMOGRAPHICS | |||
| Gender | R | Radio Buttons | Female Male DNWTP |
| Ethnicity and Race | |||
| Ethnicity | R | Radio Buttons | Hispanic/Latino Non-Hispanic DNWTP |
| Race | R | Checkboxes | American Indian or Alaska Native Asian Black or African American Native Hawaiian or Pacific Islander White DNWTP |
| Disability | |||
| Do you have? | R | Y/N | |
| Type of Disability (Check all that apply) | R | Checkboxes | Vision Hearing Mobility/Orthopedic Other DNWTP |
| TRAINING AND CAREER DEVELOPMENT SPECIFIC DATA | |||
| Non-Deliquency on US Federal Debt? | R | Radio Buttons | No Yes |
| Text Entry field if Yes | Text | ||
| Disadvantaged Background? | R | Radio Buttons | No Yes DNWTP Not Applicable to me (not an undergraduate) |
| EMPLOYMENT | |||
| Add a New Job | |||
| Employer: Select one: | R | ||
| I work in a company or institution outside NIH | Radio Button | When selected an LOV of organizations registered in the eRA Commons is available to select from | |
| I work inside NIH | Radio Button | When selected, a LOV of NIH ICs is available | |
| Start Date | R | Date | |
| End Date | O | Date | |
| Job Title | O | Text | |
| About This Job | |||
| Primary Employment? | R | Checkbox | |
| R | Radio Button | Full-Time Part-Time |
|
| This is a job working directly for the federal government. | R | Radio Button | Yes No |
| This is a faculty teaching position. | O | Checkbox | If Checked, then the following Academic Rank LOV is used |
| Academic Rank | O | LOV | Assistant Professor Associate Professor Instructor Other Professor |
| This is an academic administrative position. | O | Checkbox | If Checked, then the following Position LOV is used |
| Position | O | LOV | Assistant or Associate Dean Chairperson of Dept (or Director) Dean Other President Vice President |
| Addresss & Contact Information | |||
| R | Text | ||
| Phone | R | Text | |
| Street Address Line 1 | R | Text | |
| Street Address Line 2 | O | Text | |
| City | R | Text | |
| State | R | LOV | State List |
| ZipCode | R | Text | |
| Country | R | LOV | Country List |
| Reviewer Information | |||
| What address should NIH use to contact you for reviews? | Radio Button | Options: Use my work address Use my home address |
|
| Provide a different address If checked | |||
| Different Address | |||
| Street Address | R | Text | |
| City | R | Text | |
| State | R | LOV | |
| ZipCode | R | Text | |
| Country | R | LOV | Country List |
| Home Address | |||
| Street Address | R | Text | |
| City | R | Text | |
| State | R | LOV | State List |
| ZipCode | R | Text | |
| Country | R | LOV | Country List |
| Eligibility for Continuous Submission | LOV | LOV updated annually. Current values are: Eligibility Period: 08/16/2012 – 09/30/2013 Eligibility Period: 08/16/2013 – 09/30/2014 Eligibility Period: 08/16/2014 – 09/30/2015 |
|
| TRAINEE PERMANENT ADDRESS | |||
| Street Address | R | Text | |
| City | R | Text | |
| State | R | LOV | State List |
| ZipCode | R | Text | |
| Country | R | LOV | Country List |
| R | Text | ||
| Phone | R | Text | |
| EDUCATION | |||
| Degrees | |||
| Degree Name | R | LOV | See separate Tab for LOV |
| Degree Text (for Other) | O | Text | |
| Status: | Radio Buttons | ||
| Degree Completed | R | Radio Buttons | w/Corresponding Date Field |
| In Progress, expected | Radio Buttons | w/Corresponding Date Field | |
| Length of Program (# of Yrs) | O | LOV | 1 - 9 Years |
| Institution | R | Text | |
| Location (if not in US, indicate city & country) | O | Text | |
| Is this your Terminal Research Degree? | O | Checkbox | |
| Area of Study-Primary | O | Text | |
| Area of Study-Secondary | O | Text | |
| Area of Residency |
O | Text | |
| Residency Date Completed or Expected |
R | Date | |
| System Generated Fields | |||
| Fields used to aid in NI/ESI efforts. All are system-generated but part of the Person Profile | |||
| ESI Eligibility | Yes/No | ||
| End of Eligibility Date | Date | ||
| New Investigator Eligibility | Yes/No | ||
| Appeal Date | Date | ||
| Appeal Outcome | Text | ||
| Standard NI/ESI Eligibility is system calculated. However an exception policy has been implemented. These exceptions are handled via an appeal process. | |||
| Reference Ltrs | |||
| Referee First Name | R | ||
| Referee Last Name | R | ||
| Referee MI Name | O | ||
| Referee eMail | R | ||
| Referree Institution/Affliation | R | ||
| Referree Department | R | ||
| PI Commons User ID | R | ||
| PI Last Name | R | ||
| FOA Number | R | ||
| Reference Letter Confirmation # (if re-submitting) | O | ||
| Degrees LOV in Person Profile | |
| AB | BACHELOR OF ARTS |
| BA | BACHELOR OF ARTS |
| BOTH | OTHER BACCALAUREATE |
| BS | BACHELOR OF SCIENCE |
| BSN | BACHELOR OF SCIENCE IN NURSING |
| DC | DOCTOR OF CHIROPRACTIC |
| DDOT | OTHER DOCTOR OF MEDICAL DENTISTRY |
| DDS | DOCTOR OF DENTAL SURGERY |
| DMD | DOCTOR OF MEDICAL DENTISTRY |
| DNSC | DOCTOR OF NURSING SCIENCE |
| DO | DOCTOR OF OSTEOPATHY |
| DOTH | OTHER DOCTORATE |
| DPH | DOCTOR OF PUBLIC HEALTH |
| DPM | DOCTOR OF PODIATRIC MEDICINE |
| DRPH | DOCTOR OF PUBLIC HEALTH |
| DSC | DOCTOR OF SCIENCE |
| DSW | DOCTOR OF SOCIAL WORK |
| DVM | DOCTOR OF VETERINARY MEDICINE |
| EDD | DOCTOR OF EDUCATION |
| ENGD | FOREIGN - DOCTOR OF ENGINEERING |
| FAAN | FELLOW OF THE AMERICAN ACADEMY OF NURSING |
| JD | DOCTOR OF JURIS PRUDENCE |
| MA | MASTER OF ARTS |
| MB | FOREIGN - BACHELOR OF MEDICINE |
| MBA | MASTER OF BUSINESS ADMINISTRATION |
| MBBS | FOREIGN - BACHELOR OF MEDICINE AND SURGERY |
| MD | DOCTOR OF MEDICINE |
| MDOT | OTHER DOCTOR OF MEDICINE |
| MLS | MASTER OF LIBRARY SCIENCE |
| MOTH | OTHER MASTERS |
| MPA | MASTER OF PUBLIC ADMINISTRATION |
| MPH | MASTER OF PUBLIC HEALTH |
| MS | MASTER OF SCIENCE |
| MSN | MASTER OF SCIENCE IN NURSING |
| ND | DOCTOR OF NATUROPATHY |
| OD | DOCTOR OF OPTOMETRY |
| OTH | OTHER |
| PHD | DOCTOR OF PHILOSOPHY |
| PHMD | DOCTOR OF PHARMACY |
| PSYD | DOCTOR OF PSYCHOLOGY |
| RN | REGISTERED NURSE |
| SCD | DOCTOR OF SCIENCE |
| VDOT | OTHER DOCTOR OF VETERINARY MEDICINE |
| VMD | DOCTOR OF VETERINARY MEDICINE |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |