Change Request Memo for PHS form 6031-1

Change Request Memo for PHS form 6031-1.docx

PHS Research Performance Progress Report and Other Post-award Reporting (OD)

Change Request Memo for PHS form 6031-1

OMB: 0925-0002

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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)



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