Form 0524 - XXXX 0524 - XXXX Letter of Intent (LOI) Form

Letter of Intent –

OMB 0524 – XXXX

Expires: XX XXX XXXX

*Project Director (PD):

Last Name	First Name	Title	Department	Institution	E-Mail

Collaborating Investigators:

Last Name	First Name	Title	Department	Institution	E-Mail

Program Area Name :

Program Area Priorities (Check one program area priority):

Science Categories (Check all that apply):

*Fields outlined in red are required.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0503-0021. The time required to complete this information collection is estimated to average 2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

*Title

*Rationale

*Hypothesis or

Goals

*Objectives

*Approach

*Impacts or Outcomes

*Fields outlined in red are required.