You must include this NIH form with your application.
1. Vertebrate Animals Section
Indicate if animals will be euthanized.
If Yes, then indicate if the method is consistent with AVMA guidelines. If No, then use the text box to describe the method used and provide scientific justification.
2. Program Income Section
The answer to the question Is program income anticipated during the periods for which the grant support is requested displays as read-only, and is based on data you entered on the SF 424.
If you provide a value greater than zero for Estimated Project Income (in the Estimated Project Funding section of the SF 424), the value for Program Income will be Yes; if the Estimated Program Income is zero, the value is No.
When Program Income is Yes, then you must include at least one Budget Period. Click on the Add New Income Budget Period button. The page will refresh and show a budget period entry line. Enter the appropriate values for these additional fields.
- Budget Period: select a value (1 to 10) from the drop-down menu
- Anticipated Amount ($): enter the dollar amount for this period
- Source(s): indicate the source of the amount
Click the Add button again to include up to 5 budget periods.
You can use the Delete link to remove any existing period.
3. Human Embryonic Stem Cells Section
Select Yes if this application or subaward involves the use and/or creation of human embryonic stem cells in any portion of this research project.
If you answer Yes, additional fields will display. You will need to either use the check box to indicate that the specific cell line cannot be referenced at this time or enter the specific line(s) being used.
To enter cell line information, click on the Add New Cell Line Registration Numbers button. This will display a text box in which you can enter the cell line registration number. Click the button again to add more cell lines as needed up to a maximum of 200 stem cell lines. For more information, see GIM 36 Human Embryonic Stem Cell Research Policy and Guidelines and the NIH’s Stem Cell Registry.
4. Human Fetal Tissue Section
Select Yes if this application involves human fetal tissue obtained from elective abortions.
If you answer Yes, then two attachments are required.
- HFT Compliance Assurance
- HFT Sample IRB Consent Form
5. Inventions and Patents Section (For renewal applications only)
If you indicate Yes for Inventions and Patents, you will also need to indicate if the information has been Previously Reported.
6. Change of Investigator / Change of Institution Section
Indicate whether the Investigator and/or Institution has changed.
For a change of Institution, enter the name of the former institution.
For a change of Investigator, enter the name of the former PI/PD.