Form 1 Applicant

OMB No: 0925-0474

Expiration Date: 09/30/2011

APPLICANTS

BACKGROUND/FUNDING HISTORY

1. Prior to the T-R01, had you ever applied for an NIH award or grant as a Principal Investigator?

   1. Yes

   2. No

2. Please provide a rough estimate of the percentage of your total research funding over the past five years represented by each source listed below. (Please make sure that your answers do not add up to more than 100!).

   1. NIH

   2. Other US government

   3. Foundations (HHMI, Ford Foundation, etc)

   4. For-profit companies

   5. Hospitals, Universities or other non-profit institutions

   6. Other

3. In your opinion, what is the likelihood that your T-R01 proposal might be supported by other funders?

   1. Very unlikely

   2. Somewhat unlikely

   3. Somewhat likely

   4. Very likely

6. Was the research in your T-R01 proposal a significant departure from your previous research directions? {Choose one}

a. Yes

b. No

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number of this information collection is 0925-0474. The time required to complete this information collection is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974 Attn: PRA (0925-0474). If you have comments or concerns regarding the status of your individual submission of this form, write directly to: CSR at, 6701 Rockledge Drive, Bethesda, MD 20892-7776, Attn: Evaluation Director.

7. How would you classify your research?

a. Behavioral and/or social sciences

b. Clinical and/or translational research

c. Instrumentation and/or engineering

d. Molecular, cellular, and/or chemical biology

e. Pathogenesis and/or epidemiology

f. Physiological and/or integrative systems

g. Quantitative and/or mathematical biology

If your research does not fit into one of these categories, please describe your research area below:

APPLICATION PROCESS

8. Where did you hear about the Transformative R01 initiative?

a. Journal

b. Departmental flyer or announcement

c. NIH Guide

d. T-R01 or Roadmap website

e. Other website

5. Roadmap listserve

6. Word of mouth

7. Do not recall

9. In your opinion, how important was each of the following application components in allowing you to present your concept’s novelty, innovation and/or impact?

Application Materials	Not important 1	2	3	4	5	XTRMLY important 6
Abstract
Challenge/Impact
Approach
Appropriateness of T-R01 mech
Timeline
Bibliography

10. Were the T-R01 RFA and associated FAQs (see link below) clear in describing the kinds of projects considered to be transformative that the program seeks to fund? {Choose one}

a. yes

b. no

If it was unclear, in your opinion what are characteristics of highly innovative or transformative research? Please give examples.

OVERALL ASSESSMENT

DEMOGRAPHIC INFORMATION

11. Race (Please mark all that apply)

a. American Indian or Alaska Native

b. Asian

c. Black or African American

d. Native Hawaiian or other pacific Islander

e. White

12. Ethnicity

a. Hispanic or Latino

b. Not Hispanic or Latino

13. Age

a. Under 25

b. 25-29

c. 30-34

d. 35-39

e. 40-44

f. 45-49

g. 50-54

h. 55-59

8. 60-64

9. 65-69

10. 70-74

11. 75-79

12. 80+