416-1

Rev. 01/2021

OMB No. 0925-0001

Form Approved Through 02/28/2023

Instructions for a Change of Sponsoring Institution Application for NRSA Fellowships (F30, F31, F32, and F33) and non-NRSA Fellowships

These instructions provide general guidance on the application procedures for a Change of Sponsoring Institution for Kirschstein-NRSA Individual Fellowships (F30, F31, F32 and F33) and non-NRSA Individual Fellowships.

The required documentation for a change of sponsoring institution for fellowship may vary depending on the NIH awarding component [also known as awarding Institute/Center (IC)]. While general guidance is provided below, the fellow is strongly encouraged to contact the awarding IC for specific guidance prior to any proposed change(s) and preferably several months in advance.

NIH has transitioned the Individual Fellowship application for new, renewal, and resubmission applications to electronic. See the How to Apply - Application Guide for more information.

However, applications for a Change of Sponsoring Institution may be submitted on the paper PHS 416-1, and directly to the awarding component, instead of through Grants.gov.

The sponsoring institution is financially responsible for the use and disposition of fellowship funds. NIH prior approval is required to transfer the legal and administrative responsibility of an Individual Fellowship application from one sponsoring institution to another prior to award or for a transfer of a funded fellowship before the expiration date of the approved project period.

NIH prior approval is also required for a change in sponsor and/or change in scope of the approved research training. Note, a change in scope may require submission of a new application through the peer review process. A change in an individual fellow’s department or sponsor within the same sponsoring organization is not considered a change of sponsoring institution.

A request to an NIH awarding component to change sponsoring institutions must be made before the anticipated start date of the transfer, preferably several months in advance. Failure to do so may likely result in a delay in processing or denial of the request.

A change of sponsoring institution may occur prior to initial award, on the anniversary date or on a date within a budget period (i.e., mid-year). The preferable effective date of a change of institution is the anniversary date.

If the awarding component approves a change in sponsoring institution for a funded fellowship, a revised Notice of Award is issued to the original/former sponsoring institution to reflect the amended budget/project period end dates, decrease in the award amount and deletion of any future year commitments, as appropriate.

A separate Notice of Award is issued to the new sponsoring institution to reflect the start date, the remaining stipends and institutional allowance for the current year and any future year commitments, as applicable.

The Original/Former Sponsoring Institution must submit the following documentation to the NIH awarding component:

1. A Relinquishing Statement (PHS 3734) must be submitted by the original/former sponsoring institution. This document is a declaration by the original grantee institution that it has

agreed to relinquish responsibility for an active grant. This must occur before the expiration of the approved project period.

2. A Termination Notice (PHS 416-7) must be submitted by the original/former sponsoring institution. Item 6. of the Termination Notice should reflect the specific dates the fellow was supported at the original/former institution. In Item 7, provide the amount of stipend and number of months and days for each year supported at the original/former institution. Do not include the Institutional Allowance or any tuition as part of the stipend amount. Indicate in Item 8. that the Termination Notice is submitted due to a “Change of Sponsoring Institution”. (Note: an additional Termination Notice will be required from the new sponsoring institution once all of the support has terminated.)

The New Sponsoring Institution must submit an original, signed transfer application:

Although new, renewal, and resubmission applications for individual fellowships have transitioned to a new application package and instruction, the application for Kirschstein Individual National Research Service Award Fellowship (PHS 416-1) may still be used by the new sponsoring institution for the transfer application. The forms and application instructions can be found on the NIH Forms & Applications page at https://grants.nih.gov/grants/funding/416/phs416.htm.

The following forms and information must be submitted:

• Form Page 1: Face Page (Items 1-14)

A completed Face Page with original signature. Note, if the application is submitted to the awarding component as a PDF document, the Face Page must clearly show the signature of the Authorized Official at the new sponsoring institution. If animals or human subjects are to be used in the research training at the new sponsoring institution, IACUC and/or IRB approval should also be included in the transfer application. Certification of IRB review and approval must be provided and accepted by the awarding component before the research training may occur. Before activities with animals may begin, verification of current IACUC approval must be provided to the awarding component.

• Form Page 2: Sponsor/ Co-Sponsor Information (Items 15-17)

Assuming the sponsor is not changing, this information should reflect the new contact information for the sponsor. If the transfer application also includes a request for a change in sponsor, refer to the below application instructions for required Sponsor and Co-Sponsor information (Items 15 and 16). Include a CV of the new sponsor/co-sponsor and use continuation pages as necessary.

• Form Page 3: Goals, Activities Planned, Training Site(s), Human Embryonic Stem Cells (Items 18-21)

Items 18 and 19 are not required unless there is a change from the original submission. For Item 20, complete the information for the new Project/Performance (Training) Site. Use a continuation page if additional space is needed to list additional project/performance sites. For Item 21, complete the information on Human Embryonic Stem Cells, as requested.

• Form Page 4: Table of Contents

• PHS Fellowship Supplemental Form: Include the PHS Fellowship Supplemental Form, which includes the research training plan, from the original application so that the new sponsoring institution has a record of what was peer reviewed and approved. A scanned

image of the original submission is stored in the eRA Commons. The training at the new sponsoring institution is expected to continue as described in the original peer reviewed and approved application. Include a statement regarding whether the research training plan will continue as originally proposed or how/why the previously approved research training plan may change. A new research training plan is required if a change in scope is planned. In addition, changes in scope may require submission of a new application through the peer review process. Fellows are reminded to consult with awarding component staff regarding any proposed change in research plan prior to submission of a formal request for a change in institution. Full instructions on completing this form can be found in the PHS Fellowship Supplemental Form-specific instructions of the Application Guide for electronic applications.

• PHS Human Subjects and Clinical Trials Information: When involving NIH-defined human subjects research, clinical research, and/or clinical trials, include the following:

  • The PHS Human Subjects and Clinical Trials Information form from the original application so that the new sponsoring institution has a record of what was peer reviewed and approved. A scanned image of the original submission is stored in the eRA Commons. This form is separate from the PHS Fellowship Supplemental form, but part of the overall application.

  • A statement indicating whether the study records have changed from the original submission as an “Other Requested Information” attachment in the PHS Human Subjects and Clinical Trials Information form.

  • Study records: If the study records have changed, provide new study records (this includes any inclusion enrollment reports) in the PHS Human Subjects and Clinical Trials Information form to reflect the updates. If your study records have not changed, you do not need to provide new study records: you only need to provide the PHS Human Subjects and Clinical Trials Information form from the original application, as noted above.

You must use the separate fillable PDF for the PHS Human Subjects and Clinical Trials Information form if you are submitting new/updated study records. Full instructions on completing this form can be found in the PHS Human Subjects and Clinical Trial Information form-specific instructions of the Application Guide for electronic applications. Please note that the PHS Human Subjects and Clinical Trials Information fillable form can be opened in Internet Explorer. However, you may download it from any browser.

Note: Although certain question in the form apply to every applicant, others apply only to certain applicants. For example, you will only be able to extract (and fill out) a study record if your answer is “Yes” to the “Are Human Subjects Involved?” question at the beginning of the form. Moreover, although the form-specific instructions in the Application Guide apply, certain form behavior differences will occur in your paper application. Differences include:

• None of your answers will be pre-populated from any previous forms.

• There are no validations on the paper version of the form, so form behavior will differ from the electronic version. However, you must still complete all required sections.

• Training Plan, Environment, Research Facilities: Describe the research training plan that you have developed specifically for the applicant/fellow. Include items such as classes, seminars, and opportunities for interaction with other groups and scientists.

Describe the research environment and available research facilities and equipment. Indicate the relationship of the proposed research training to the applicant's career goals. Describe the skills and techniques that the applicant will learn. Relate these to the applicant's career goals.

• Checklist Form Page: Under Type of Application, please check the box for Change of Sponsoring Institution and include the Name of the Former Institution in the space provided. The rest of the checklist need only be completed, as applicable.

• Progress Report: If the transfer is to occur on the anniversary date, in addition to the application pages above, please also submit a Research Performance Progress Report (RPPR) in the eRA Commons and a completed PHS Human Subjects and Clinical Trial Information form (including an inclusion enrollment report), if applicable.

Note: Letters of reference are not required for a transfer application.

Submitting Change of Sponsoring Institution Application Material

All change of sponsoring institution application materials (relinquishing letter/statement, transfer application, termination notice) from both the original/former and new sponsoring institutions must be submitted directly to the NIH awarding component (IC). In most cases, all materials will be submitted to the assigned grants management specialist. However, consult the awarding component (IC) for specific submission instructions. Do not submit the transfer application to the Center for Scientific Review.

1