Change Request Memo for PHS form 6031-1

DATE: April 27, 2020

TO: Quinn Hirsch

Office of Management and Budget (OMB)

Reports Clearance Officer, DHHS

FROM: Mikia P. Currie

Chief, Project Clearance Branch

SUBJECT: Change Request to a Currently Approved Form

(OMB# 0925-0002, Expiration Date 2/28/2023)

This is a request for OMB to approve a non-substantial modification to Form PHS 6031-1 Annual Payback Activities Certification (APAC).

The changes to PHS 6031-1 Annual Payback Activities Certification (APAC) per red line strikethrough attached:

• updated language under Payback Requirements section to provide clarifying guidance on how individuals may satisfy the obligation

• updated the mailing address for the NRSA Payback Service Center

Your full consideration is appreciated.

Attachment A: PHS 6031-1 Annual Payback Activities Certification (APAC)