Use prescribed by NIH Manual 11651 NIH Agreement Number including Mod No2 Paying Agency3 Receiving Agency4 Title of the Agreement5 Summary of Substance of the Agreement include purpose resources commi ID: 899299
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1 8. Agency Location Code10. Address11. Ag
8. Agency Location Code10. Address11. Agency Location Code13. AddressDepartment of Health and Human ServicesAgency Agreement and Clearance Use prescribed by NIH Manual 11651. NIH Agreement Number (including Mod. No.)2. Paying Agency3. Receiving Agency4. Title of the Agreement5. Summary of Substance of the Agreement (include purpose, resources committed: funds, personnel, equipment, facilities, etc.) PayingAgencyReceivingAgency Billing Information 21. Receiving22. Agreement No.23. Appro-Federal Agency(for NIH Y3)priation28. NIH Project Officers Name29. IC30. Phone31. NIH Administrative/Budget Office Contact32. IC Accounting InformationPaying Agency14. Paying15. Agreement No.16.Federal Agency(for NIH Y1/Y2)AppropriationAccounting InformationReceiving Agency NIH 1742 (Rev. 4/05) 24. CAN25. Amount26. Signatories (Name and Title) 17. CAN18. Amount19. Signatories (Name and Title)