Exemplar Consent Form LOI2-BIO-18

Exemplar Consent Form
OMB #: 0925-XXXX
Expiration Date: XX/XX/XXXX

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 (0925XXXX). Do not return the completed form to this address.

Exemplar Consent Form
OMB #: 0925-XXXX
Expiration Date: XX/XX/XXXX

Exemplar Consent Form
OMB #: 0925-XXXX
Expiration Date: XX/XX/XXXX

Exemplar Consent Form
OMB #: 0925-XXXX
Expiration Date: XX/XX/XXXX

Exemplar Consent Form
OMB #: 0925-XXXX
Expiration Date: XX/XX/XXXX

Exemplar Consent Form
OMB #: 0925-XXXX
Expiration Date: XX/XX/XXXX