Form 4 Network of Minority Health Research Investigators (NMRI)

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

OMB #0925-0748
Expiration Date: 12/2019
Network of Minority Health Research Investigators (NMRI) Enrollment Form
Public reporting burden for this collection of information is estimated to average 15 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 (0925-0748). Do not return the completed
form to this address.

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Collection of this information is authorized under 42 U.S.C. 241 and 5 U.S.C. 301. The primary use of this information is to provide short-term research
education for high school and undergraduate students from racial and ethnic minority or disadvantaged backgrounds in order to expose them to
research within the mission of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health (NIH)
and to determine their eligibility to receive grants. This information may be disclosed to NIH administrators, NIDDK Network of Minority Health Research
Investigators (NMRI) staff, university reviewers, and NMRI review committee members for administrative and educational purposes. Submission of this
information is voluntary, however, in order for us to consider you for enrollment in the NMRI program and potential grant funding, you should complete
all the required fields.