OMB Number: 0925-0740
Exp Date: 07/31/2022
Public reporting burden for this collection of information is estimated to average 5-minutes per submission. 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 0925-0648. Do not return the completed form to this address.
Please note: Only ﬁelds with an * are required unless otherwise noted.