Instructions for PHS 416-1 Rev. 06/02

Form Approved Through 06/30/05 OMB No. 0925-0002

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health and
Agency for Healthcare Research and Quality

Ruth L. Kirschstein National Research Service Award
Individual Fellowship Application Form PHS 416-1

Updated: 08/29/2003 (see below)

The text of the PHS 416-1 instructions is available below in html format. These instructions are also available in Adobe Acrobat format. Also, see the 08/29/2003 NIH Guide Notice for information on the Update of the PHS 398, 2590 and 416 Forms.

The PHS 416-1 forms are available in fillable Microsoft Word (MS Word) and Adobe Acrobat Portable Document (PDF) format below. See the NIH Forms and Applications Page for additional forms and instructions.

Notice: Requirement of DUNS Numbers on NIH Applications - Effective October 1, 2003, use of the Dun and Bradstreet (D&B;) Data Universal Numbering System (DUNS) number will be required when applying for Federal grants or cooperative agreements. See NIH Guide Notice dated August 14, 2003 and the DUNS Q&A; (MS Word) document for more information.

Instructions For Downloading Documents and Electronic Forms are also available with help on downloading and processing (printing and viewing) Acrobat and other files. Acrobat Reader software, which is free, must be obtained in order to view and print Acrobat files. Please see the Adobe Acrobat or PDF Forms section for information on using the fillable PDF forms.

Note: See the October 30, 2002 NIH Guide Notice for information on the revised 416-1 and 416-9 instructions and fillable forms, including notable changes since the last version. Also see the summary of Important Changes/Reminders. The new instructions and forms may now be used by applicants. Beginning with the April 2003 application receipt date and beyond, use of the new version (Rev. 6/02) is required.

If you have any questions or need assistance completing this application or forms, direct inquiries may be made to GrantsInfo@nih.gov or 301-435-0714.

---

Microsoft Word (MS Word) and Portable Document Format (PDF) Forms

Individual Fillable 416-1 Forms	MS Word Format	PDF Format
Form Page 1: Face Page	MS Word	PDF
Form Page 2:	MS Word	PDF
Form Page 3 - Table of Contents	MS Word	PDF
Form Page 4 - Scholastic Performance	MS Word	PDF
Form Page 5 - Background	MS Word	PDF
Form Page 6 - Research Experience/Training Plan:	MS Word	PDF
Personal Data Form	MS Word	PDF
Form Page 7 - Biographical Sketch	MS Word	PDF
Form Page 7 - Biographical Sketch Sample	MS Word	PDF
Form Page 8 - Facilities and Commitment	MS Word	PDF
Form Page 9 - Checklist	MS Word	PDF
Targeted/Planned Enrollment Table	MS Word	PDF
Inslusion Enrollment Report	MS Word	PDF
Continuation Page	MS Word	PDF
References Page	MS Word	PDF
Combined Fillable 416-1 Forms
Note: Combined Files DO NOT include the Biographical Sketch or Continuation pages. See Above for Individual Form Files.)
All 416-1 Forms in Single File	MS Word	PDF
416-1 Instructions
416-1 Instructions File	N/A (html version available)	PDF

Note: Some files are large and make take a few minutes to download.

---

TABLE OF CONTENTS

IMPORTANT CHANGES. 1

Changes to the PHS 416-1 Form and Instructions. 1

Electronic Format 1

Human Subjects Research. 1

Vertebrate Animals. 1

Changes in the Application Form Pages. 1

Changed Format Pages. 1

New Format Pages. 1

Reminder 1

FOREWORD. 2

Grants Information. 2

Grants Policy Statements. 2

NIH Guide for Grants and Contracts. 2

SECTION I. PREPARING THE APPLICATION. 3

A. Introduction 3

1. Program Announcements and Requests for Applications. 3

2. Authorization. 3

B. General Instructions. 3

1. Format Specifications. 3

2. Page Limitations and Content Requirements. 4

C. Specific Instructions for Applicant (Part I) 6

1. Face Page (Form Page 1) 7

2. Form Page 2. 9

3. Table of Contents (Form Page 3) 9

4. Scholastic Performance (Form Page 4) 9

5. Background (Form Page 5) 9

6a. Research (Form Page 6) (Part 1) 10

6b. Research (Form Page 6) (Part 2) 10

7. Personal Data on Kirschstein-NRSA Individual Fellowship Applicant Page. 22

8. Checklist (Form Page 9) - Applicant Section. 22

9. Assurances and Certifications. 22

10. References. 22

D. Specific Instructions for Sponsors (Part II) 23

1. Face Page. 23

2. Form Page 2. 26

3. Biographical Sketch (Form Page 7) 26

4. Facilities and Commitment (Form Page 8) 26

5. Checklist (Form Page 9) - Sponsoring Institution Section. 28

6. Assurances and Certifications. 28

SECTION II. SUBMITTING THE APPLICATION. 29

A. Instructions 29

1. Number of Copies, Binding, and Mailing Address. 29

2. Application Mailing Address. 29

3. Application Receipt Dates. 30

B. The Peer Review Process. 30

1. Application Assignment Information. 30

2. Review Process. 30

3. Kirschstein-NRSA Individual Fellowship Application Evaluation Criteria. 31

C. Interactions Before Submission. 31

D. Interactions After Submission. 32

E. Interactions After Review. 32

SECTION III. OTHER INFORMATION. 33

A. Patents and Inventions. 33

B. Policies, Assurances, and Certifications. 33

Human Subjects. 33

Research on Transplantation of Human Fetal Tissue. 36

Research Using Human Embryonic Stem Cells. 36

Vertebrate Animals. 36

Debarment and Suspension. 37

Drug-Free Workplace. 37

Nondelinquency on Federal Debt 38

Research Misconduct 38

Assurance of Compliance (Civil Rights, Handicapped Individuals, Sex Discrimination, Age Discrimination) 38

Financial Conflict of Interest 39

Metric Program.. 39

Government Use of Information Under the Privacy Act 39

Information Available to the Applicant 40

Information Available to the General Public. 40

Recombinant DNA and Human Gene Transfer Research. 41

C. Information Resources. 41

D. Extramural Program Guidelines. 41

SECTION IV. KIRSCHSTEIN-NRSA FIELDS OF TRAINING. 42

SECTION V. KIRSCHSTEIN-NRSA ASSURANCE. 44

SECTION VI. GLOSSARY. 46

---

Notable Changes Made to PHS 416-1 Form Pages After Initial Release on October 30, 2002:

August 29, 2003 Changes:
• Shading was removed from the fillable form fields in the PDF files. This was to correct the problem when JavaScript was disabled or not supported, the forms fields would print with shaded backgrounds, rendering them unable to be scanned by NIH staff. Also, see the 08/29/2003 NIH Guide Notice for information on the Update of the PHS 398, 2590 and 416 Forms.

August 7, 2003 Changes:
• All forms have been modified to be more compatible with existing software and Microsoft Word (MS Word) files have replaced previous versions of Rich Text Format (RTF) files. In addition, links in the instructions have been updated to reflect these changes.

April 18, 2003 Changes:
• Formatting adjustments have been made to all RTF and PDF versions of the forms in the table above. The previous versions will be accepted; however, we strongly encourage use of the new forms.


April 14, 2003 Changes:
• The Responsible Conduct of Research language in Section I.C, Item 30e of the instructions has been revised to clarify responsibilities in this area. In addition, the Application Receipt Date for the Minority and Disability Programs has been corrected to May 1. See Section II.A.3 of the instructions. The Important Changes/Reminders document has been updated accordingly.


March 28, 2003 Changes:
• Formatting adjustments have been made to the RTF and PDF versions of the forms with a red asterisk in the table above. The previous versions will be accepted; however, we strongly encourage use of the new forms. The combined version with the updated forms will be available soon.


November 27, 2002 Changes:
• Minor Formatting adjustments have been made to RTF version of Face Page (Form Page 1) to provide greater usability. In addition, the file with All 416-1 Forms in Single File has been updated accordingly. Use of the prior version of the Face Page is still acceptable for applications in progress. However, applicants are encouraged to replace previous versions of these files with the updated versions, at their earliest convenience.


November 12, 2002 Changes:
• Formatting adjustments have been made to RTF versions of Form Pages 2, 5, 7 and 8 as well as the Continuation Page to allow for pasting blocks of text into forms fields. The Combined 416-1 RTF Forms file has been updated accordingly. Please discard previous versions of the forms and replace with current versions shown above.


November 7, 2002 Changes:
• Necessary formatting adjustments have been made to all forms to meet font and margin requirements. Please discard previous versions of the forms and replace with current set shown above.

---

[Previous Page]     [Next Page]

[Changes]  [Foreword]  [Sections IA-B]  [Section IC-1]  [Section IC-2]  [Section IC-3]  [Section IC-4]
[Section ID]  [Section II]  [Section III]  [Section IV]  [Section V]  [Glossary]

Go to NIH Forms and Applications Page

---

Note: If you need help accessing any files above that are labeled as PDF, RTF, MS Word, Excel, PowerPoint or RealPlayer, see Instructions For Downloading Documents and Electronic Forms.