NIH Extramural Harassment Web Form (OD/OER)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Form	Form	Modified	Available
Supporting_StatementA_ OER Harassment_5.20.26.docx	Supporting Statement A	Uploaded 2026-06-17	Available
Harassment 30day.pdf	Supplementary Document	Uploaded 2026-06-17	Available
Electronic Research Administration 4202026.pdf	Supplementary Document	Uploaded 2026-06-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
255943	Inform NIH About Harassment or Discrimination Concerns	Form	Modified	Form

ICR Details

OMB Control No: 0925-0777	ICR Reference No: 202605-0925-003
Status: Received in OIRA	Previous ICR Reference No: 202209-0925-002
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: NIH Extramural Harassment Web Form (OD/OER)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/17/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	240	0
Time Burden (Hours)	60	0
Cost Burden (Dollars)	0	0

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Abstract: This is a reinstatement request without changes to continue collecting information about possible concerns regarding harassment, bullying, retaliation or hostile working conditions. The NIH Grants Policy Statement Section 4 outlines that NIH recipient institutions are expected to provide safe and healthful working conditions for their employees and foster work environments conducive to high-quality research, regardless of the recipient institution. The Consolidated Appropriations Act, 2022 (Public Law 117-103), Division H, Title II, Section 239 requires that, “[t]he Director of the National Institutes of Health shall hereafter require institutions that receive funds through a grant or cooperative agreement during fiscal year 2022 and in future years to notify the Director when individuals identified as a Program Director or Principal Investigator (PD/PI) or as Senior/Key personnel in an NIH notice of award are removed from their position or are otherwise disciplined due to concerns about harassment, bullying, retaliation, or hostile working conditions.” Therefore, NIH recipient institutions are required to notify NIH when individuals identified as PD/PI or other Senior/Key personnel in an NIH notice of award are removed from their position or are otherwise disciplined by the recipient institution due to concerns about harassment, bullying, retaliation or hostile working conditions. The secure Harassment Web Form will be used to collect notifications from institutional Authorized Organization Representatives (AORs) which must include, at a minimum, the name of the AOR submitting the notification, the name of the individual of concern, a description of the concerns, the action(s) taken, and any anticipated impact on the NIH-funded award(s).

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Authorizing Statute(s): PL: Pub.L. 117 - 103 239, Division H, Title II Name of Law: The Consolidated Appropriations Act, 2022
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 12203	03/12/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 36153	06/16/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Inform NIH About Harassment or Discrimination Concerns	1	Form

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ICR Summary of Burden

table that charts list 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	240	0	0	240	0	0
Annual Time Burden (Hours)	60	0	0	60	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 is a reinstatement without change.

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Annual Cost to Federal Government: $125,844

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

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Common Form ICR:  No

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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: 06/17/2026

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