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OMB No: 0925-0361
Form approved for use through 05/31/2029
NIH 2674-13

Loan Repayment Program

Reference Letter Submission

The Reference Letter Submission with confirmation number: for has been successfully removed.

You will receive a confirmation email at . DLR and the applicant will also receive confirmation emails.

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Identify the applicant for whom you wish to submit your reference letter.

Hint: You should have received the applicant's Commons ID in an email.

Submit a Replacement Letter or Remove Previous Submission

Have you already submitted a letter and now wish to update or remove it?

Confirmation number can be at most a 10 digit number.
Before you submit a reference letter, please inform us of your role for this application. Choose Referee if you were only asked to submit a reference letter. Choose Mentor if you are the primary research mentor for this applicant (in addition to submitting a reference letter, mentors will be asked to provide concurrences of the applicants research documents in this portal and, separately, an NIH formatted biosketch to the applicant).

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Just one more request for review before moving forward to the next step...

Please review your previously submitted contact details, and make any changes needed.

Required Field

First Name is a required Field
Last Name is a required Field
Our communications will be sent to this address. To update your email address at a later date, go to the Personal Profile in your eRA Commons Account.
Email must be in valid format
Employment Organization is a required Field
Position Title is a required Field

Previous letter submission details


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Submission Details

Public reporting for this collection of information is estimated to average 30 minutes, 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 the 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, Attention: PRA 0925-0361. Do not return the completed form to this address.

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