Assurance Statement

This form is designed to comply with the requirements of NIG Notice NOT-OD-06-054, issued April 7, 2006: http://grants.nih.gov/grnats/guide/notice-files/NOT-OD-06-054.html. Effective May 10, 2006, the National Institutes of Health )NIH) requires that the applicant organization secure and retain a written assurance from the Principal Investigator (PI) prior to submitting an application, progress report, and prior approval request. NIH also requires that when multiple PIs are proposed in an application, this assurance must be retained for all named PIs.

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Grant Award number (if known)

Principal Investigator

I hereby certify that:

The information submitted within the application and during the award period, which includees Continuation and Supplemental proposals and Prior Approval Requests, is true, complete, and accurate to the best of my knowledge

I agree

Any false, fictitious, or fraudulent statements or claims may subject me to criminal. civil, or administrative penalties

I agree

I agree to accept responsibility for the scientific conduct of the project and to provide the required progress reports if a grant is awarded as a result of this application.

I agree

Principal Investigator Name

Principal Investigator Signature Date

List all additional PIs

Principal Investigator Name

Principal Investigator Signature Date

Principal Investigator Name

Principal Investigator Signature Date

Principal Investigator Name

Principal Investigator Signature Date

By filling out my name below, I acknowledge that I am responsible for all work submitted and that I have read and agree to current IRB guidelines.

Your Name Here

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Your submission has been received.

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Assurance Statement

Assurance Statement

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