PHS Applications and Pre-award Related Reporting (OD)

Forms and Documents

Document Name	Status
Form 1 PHS 398 Paper Form	Unchanged
Form 1 NIH Other Transaction Application Form Form and Instruction	New
Form 1 Data Management Sharing Plan Form and Instruction	New
Form 16 398/424 PHS Human Subjects and Clinical Trial Information (includes inclusion enrollment report) Form and Instruction	Unchanged
Form 29 PHS 416-5 Form and Instruction	Unchanged
Form 1 SBIR/STTR Funding Agreement Certification Form and Instruction	Modified
Form 26 VCOC Certification Form and Instruction	Unchanged
Form 1 PHS 6031 Form and Instruction	Unchanged
Form 19 416-1 Form and Instruction	Unchanged
Form 1 Biosketch (Fellowship) Form and Instruction	Modified
Form 15 PHS Fellowship Supplemental Form (includes F reference letters) Form and Instruction	Modified
Form 12 Biosketch (424 Electronic) Form	Unchanged
Form 1 PHS 398 Career Development Award Supplemental Form Form and Instruction	Modified
Form 10 Data Tables Form and Instruction	Unchanged
Form 1 PHS 398 Research Training Program Plan Form and Instruction	Modified
Form 1 PHS 398 Research Plan Form and Instruction	Modified
Form 7 PHS 398 Training Subaward Budget Attachment(s) Form Form	Unchanged
Form 6 PHS 398 Training Budget Form	Unchanged
Form 5 PHS 398 Modular Budget Form and Instruction	Modified
Form 4 PHS 398 Cover Page Supplement Form	Unchanged
Form 3 PHS Assignment Request Form Form	Unchanged
Supporting Statement A for 0925-0001_FORMS-H (1) (2) (1) (1).docx Supporting Statement A	2022-10-05
NIH Other Support and In-Kind_Instructions_07-2022_clean.docx Supplementary Document	2022-10-05
Other Support Format Page_07-2022_clean.docx Supplementary Document	2022-10-05
0001 30 day notice.pdf Supplementary Document	2022-10-05
Fellowship Biographical Sketch Format Page_07-2022_mark-up.docx Supplementary Document	2022-07-21
General Non-Fellowship Biographical Sketch Format Page_07-2022_mark-up.docx Supplementary Document	2022-07-21
NIH Other Support Format Page_07-2022_mark-up.docx Supplementary Document	2022-07-21
SBIR-Funding-Agreement-Certification_5-2022_mark-up.docx Supplementary Document	2022-07-21
STTR-Funding-Agreement-Certification_5-2022_mark-up.docx Supplementary Document	2022-07-21
0001 OMB Change Request Memo_July 2022v2.docx Justification for No Material/Nonsubstantive Change	2022-07-21
pub 30day 0001 2021-17031.pdf Supplementary Document	2021-08-10
Att D NIH Other Support and In-Kind_Instructions_6-28-2021.docx Supplementary Document	2021-08-10
Att C NIH Other Support Format Page_6-28-2021.docx Supplementary Document	2021-08-10
Attachment 19 HHS Approved PIA - Electronic Research Administration 7152019.docx Supplementary Document	2019-12-27

IC Document Collections

IC ID	Document Title	Status
37814	PHS 398 Paper Form	Unchanged
256274	NIH Other Transaction Application Form Form and Instruction	New
256273	Data Management Sharing Plan Form and Instruction	New
225108	398/424 PHS Human Subjects and Clinical Trial Information (includes inclusion enrollment report) Form and Instruction	Unchanged
217591	PHS 416-5 Form and Instruction	Unchanged
217570	SBIR/STTR Funding Agreement Certification Form and Instruction	Modified
217569	VCOC Certification Form and Instruction	Unchanged
217568	PHS 6031 Form and Instruction	Unchanged
217567	416-1 Form and Instruction	Unchanged
217566	Biosketch (Fellowship) Form and Instruction	Modified
217563	PHS Fellowship Supplemental Form (includes F reference letters) Form and Instruction	Modified
217561	Biosketch (424 Electronic) Form	Unchanged
217560	PHS 398 Career Development Award Supplemental Form Form and Instruction	Modified
217559	Data Tables Form and Instruction	Unchanged
217558	PHS 398 Research Training Program Plan Form and Instruction	Modified
217557	PHS 398 Research Plan Form and Instruction	Modified
217556	PHS 398 Training Subaward Budget Attachment(s) Form Form	Unchanged
217555	PHS 398 Training Budget Form	Unchanged
202980	PHS 398 Modular Budget Form and Instruction	Modified
202963	PHS 398 Cover Page Supplement Form	Unchanged
202959	PHS Assignment Request Form Form	Unchanged

ICR Details

OMB Control No: 0925-0001	ICR Reference No: 202210-0925-002
Status: Received in OIRA	Previous ICR Reference No: 202207-0925-002
Agency/Subagency: HHS/NIH	Agency Tracking No: 19797
Title: PHS Applications and Pre-award Related Reporting (OD)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/05/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	09/30/2024
Responses	486,749	413,393
Time Burden (Hours)	2,175,670	2,023,454
Cost Burden (Dollars)	0	0

---

Abstract: The National Institutes of Health (NIH) and other Public Health Service (PHS) agencies currently use the Research and Research Training Grant Applications and Related Forms and Ruth L. Kirschstein National Research Service Award (NRSA) Applications and Related Forms (0925-0001 Expiration Date: February 28, 2023). This collection is being revised to convert the Inclusion Enrollment Report form to a Common form to include the Department of Defense (DoD) and any other agencies who wishes to use this form in the future. The forms original use will remain the same from previous submissions however, it will take on a new OMB# and expiration date from the other forms associated with this submission. The Inclusion Enrollment Report is used for all applications involving NIH-defined clinical research. This form is used to report both planned and cumulative (or actual) enrollment, and describes the sex/gender, race, and ethnicity of the study participants. In addition to converting the Inclusion Enrollment Report to a common form, other revisions include NIH requiring applicants and recipients to provide their Unique Entity Identifier (UEI) instead of the Data Universal Number System (DUNS) number starting in January 2022. Also, the application forms will be updated to align with the Grants.gov updated Country and State lists.

---

Authorizing Statute(s): US Code: 42 USC 300 Name of Law: Public Health Service Act
   US Code: 42 USC 286 Name of Law: Public Health Service Act
   US Code: 42 USC 216 Name of Law: Public health Service Act
   US Code: 42 USC 285 Name of Law: public Health Serice Act
   US Code: 42 USC 241 Name of Law: Public Health Service
   US Code: 42 USC 288 Name of Law: Public Health Serive Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 34891	06/08/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 60180	10/04/2022
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 21

IC Title	Form No.	Form Name
398/424 PHS Human Subjects and Clinical Trial Information (includes inclusion enrollment report)	16, 18, 17	Landing Page ,   Inclusion Enrollment Report ,   HSCT Sections 1-6
416-1	19, 20, 21, 22, 24, 23	Attachment 7B PHS 416-1 Face Page 1 ,   Attachment 7C PHS 416-1 Face Page 2 ,   Attachment 7D PHS 416-1 Face Page 3 ,   Attachment 7E PHS 416-1 Face Page 4 ,   Attachment 7F PHS 416-1 Checklist Form Page ,   Attachment 7G PHS 416-1 Continuation Page
Biosketch (424 Electronic)	12	General Non-Fellowship Biographical Sketch Format Page
Biosketch (Fellowship)	1	General Non-Fellowship Biographical Sketch Format Page
Data Management Sharing Plan	1	DMS Plan Format Page
Data Tables	10	Introduction to the Data Tables
NIH Other Transaction Application Form	1	Other Transaction Application Form Screenshots
PHS 398 Career Development Award Supplemental Form	1	PHS 398 Career Development Form Instructions
PHS 398 Cover Page Supplement	4	PHS 398 Cover Page Supplement Forms
PHS 398 Modular Budget	5	PHS 398 Modular Budget Form
PHS 398 Paper	1, 2	PHS 398 Paper Application Forms ,   PHS 398 Paper Application Instructions
PHS 398 Research Plan	1	PHS 398 Research Plan Form
PHS 398 Research Training Program Plan	1	PHS 398 Research Training Program Plan
PHS 398 Training Budget	6	PHS 398 Training Budget Form
PHS 398 Training Subaward Budget Attachment(s) Form	7	Attachment 5M PHS 398 Training Subaward Budget Form
PHS 416-5	29	PHS 416.5
PHS 6031	1	PHS 6031
PHS Assignment Request Form	3	PHS Assignment Reqest Form
PHS Fellowship Supplemental Form (includes F reference letters)	15, 1	eRA Commons Profile Data Elements ,   PHS Fellowship Supplemental Form
SBIR/STTR Funding Agreement Certification	1, 2	SBIR Funding Agreement Certification ,   STTR Funding Agreement Certification
VCOC Certification	26	VCOC Certification

---

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	486,749	413,393	0	73,356	0	0
Annual Time Burden (Hours)	2,175,670	2,023,454	0	152,216	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This submission represents a program change due to the implementation of the NIH Data Management and Sharing Policy and the introduction of the new optional Data Management and Sharing Plan format page. Burden hours of 146,234 were added to the new Data Management and Sharing Plan line item. The application form for the NIH Other Transactions was also added to this collection; 2,629 burden hours were added to the NIH Other Transaction Application Form line item. The PHS Fellowship Supplemental Form (includes F reference letters) estimated time went from 12.5 hours to 13 hours. The burden estimate has now been adjusted to a difference of 152,216.

---

Annual Cost to Federal Government: $238,382

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/05/2022

---