Form 1 User Accounts

MyOITE USER ACCOUNTS (NIH-ONLY)
OMB Clearance Number: 0925-0299
Expiration Date: 31-May-2024
Burden Time: 3 minutes

Collection of this information is authorized by The Public Health Service Act, Section 410 (42 USC 285). Rights of participants are protected by The Privacy Act of 1974.
Participation is voluntary, and there are no penalties for not participating or withdrawing from the study at any time. The information collected in this study will be
kept private to the extent provided by law. Names and other identifiers will not appear in any report of the study. Information provided will be combined for all
participants and reported as summaries.
Public reporting burden for this collection of information is estimated to average 3 minutes 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. An agency may not conduct or
sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding
this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705
Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0299). Do not return the completed form to this address.

Q1 First Name (Given Name):
________________________________________________________________

Q2 Last Name (Family Name):
________________________________________________________________

Q3 Email Address (check accuracy):
________________________________________________________________
Q4 NIH Badge Number (###-####-###):
________________________________________________________________

Q5 NIH Training Position or Role:
o Summer Intern
o Postbaccalaureate
o Graduate Student (master degree)
o Graduate Student (doctoral degree)
o Medical Student
o Dental Student
o Postdoctorate: IRTA / CRTA
o Postdoctorate: Clinical Fellow
o Postdoctorate: Research Fellow
o Postdoctorate: Visiting Fellow
o Staff Clinician
o Staff Scientist
o NIH Investigator
o NIH Training Director
o NIH Staff
o OITE Staff

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Q6 NIH Institute-Center:
o CC
o CIT
o CSR
o FIC
o NCATS
o NCCIH
o NCI-CCR
o NCI-DCEG
o NEI
o NHGRI
o NHLBI
o NIA
o NIAAA
o NIAID
o NIAMS
o NIBIB
o NICHD
o NIDA
o NIDCD
o NIDCR
o NIDDK
o NIEHS
o NIGMS
o NIMH
o NIMHD
o NINDS
o NINR
o NLM
o OD
Q7 NIH Campus:
o Bethesda, Maryland (main campus)
o Baltimore, Maryland
o Frederick, Maryland
o Gaithersburg, Maryland
o Poolesville, Maryland
o Rockville, Maryland
o Framingham, Massachusetts
o Research Triangle Park, North Carolina
o Hamilton, Montana
o Phoenix, Arizona
o other

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