Nanofab Form

NanoFab Non-NIST Project Application Form
* Indicates required field
OMB Control Number: 0690-0038
Expiration Date 07/31/2026
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an
information collection subject to the requirements of the Paperwork Reduction Act of 1995 unless the information collection has a currently valid OMB Control
Number. The approved OMB Control Number for this information collection is 0690-0038. Without this approval, we could not conduct this survey/information
collection. Public reporting for this information collection is estimated to be approximately 1 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. All responses to this
information collection are voluntary. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for
reducing this burden to the National Institute of Standards and Technology: 100 Bureau Drive, Mail Stop 6201, Building 216, Gaithersburg, MD 20899, Attn: Group
Leader/Rob Ilic, robert.ilic@nist.gov.

New Project? *
New Project
If the purpose of the project is substantially different from a prior project, please start a new project.

Follow-on to Project
If it is a direct continuation of work begun under a prior project, enter the prior NanoFab Project Number

Proprietary Project? *
Proprietary Project
To be proprietary, no federal employees, including NanoFab staff members, may assist in the work. By Department of Commerce policy, full rates will be charged.

Non-Proprietary Project
Non-proprietary projects are expected to freely share any processes developed and the outcome of the work, and may be conducted with the assistance of NanoFab staff members.

I learned about the NanoFab from: *

Please help us understand the most effective outreach mechanisms by identifying how you learned about the NanoFab.

Principal Investigator
First Name *

Last Name *

Work Phone *

Work Email *

Employer Name *

Employer Type *
- Select -

Employer Address *
Country *
United States
Street address *

City *

State *
- Select Zip code *

Project Title *

Enter a short, descriptive title, sufficient for someone to understand the main
purpose of the project. If this is a follow-on project, update the title if the purpose
has changed; if it has changed substantially, start a new project.

Estimate Budget *

This estimate will generally be arrived at in coordination with the NanoFab
Manager.

By design, the nanofab project application form data entry fields are not intended for the insertion of sensitive personally identifiable information (SPII), and
may contain data or detail which, in aggregate context, can be particularly sensitive or confidential. Please take Federal best practice precautions in not
inserting any extraneous data or any data which is not explicitly requested. For example, since social security number and passport numbers are NOT
requested, please do not enter this SPII in any form data fields. You should only provide the required information.
General Description *

Provide a concise description (2 to 4 sentences) of the goal of the overall research program to which this NanoFab project will contribute and how this project will contribute to that goal. This description
should be written for the scientific generalist and enable one to quickly ascertain the purpose of your research and how using the NanoFab will help achieve it.

Materials and/or Chemicals planning to bring into the NanoFab *

After consulting with the NanoFab Manager, please list any materials and chemicals you plan to bring to the NanoFab and provide Safety Data Sheet (SDS). Please type NA if it is not applicable.

Research Area *
Electronics
Bio
Optics/Photonics/
Imaging and Characterization
Plasmonics MEMS
Test Samples
Other…

Supplemental Material
Provide additional project/process related information as needed.

Upload a file
Type the name of the file you uploaded to Box.com.
file.pdf
Please name the file with your Last Name_First Name.

Technical Description *

Provide a step-by-step process flow, if appropriate. For complex projects, you may summarize some steps and reference publications that describe the detailed methods. Indicate if any of the steps will
be performed (at cost) by NanoFab staff members (non-proprietary projects only). Attach additional pages or supplemental material, as necessary

Justification: Briefly explain how you expect this project will support NIST’s mission to advance measurement science, standards, or technology *

Although direct support of the NIST mission is not a prerequisite for using the NanoFab, potential contributions to this mission are one factor used in evaluating the relative merit of each project
application. If your project is not expected to contribute in this way, enter “N/A”.

Justification: Briefly explain how you expect this project will support the CNST’s mission to advance fundamental nanoscale science and technology, and/or
accelerate commercial production of nanotechnology that will benefit the public *

Although direct support of the CNST mission is not a prerequisite for using the NanoFab, potential contributions to this mission are one factor used in evaluating the relative merit of each project
application, and a major factor used to decide whether the CNST will provide financial support through reduced rates, if requested. If you have requested to be considered for reduced rates, this section
must be filled in. If your project is not expected to contribute in this way, enter “N/A”

Acknowledgement Requirement
In submitting this application, the Principal Investigator agrees to the following:
To include the acknowledgement “Research performed in part at the NIST Center for Nanoscale Science and Technology NanoFab” in all research
publications and published documents reporting results associated with or made possible by this project.
To acknowledge the NIST Center for Nanoscale Science and Technology NanoFab in presentations reporting results associated with or made possible by this
project.

While NIST will take reasonable precautions to protect any personally identifiable information (PII) provided on this form, the Department of Commerce considers this
PII to be non-sensitive. The electronic transmission of non-sensitive PII is equivalent to transmitting the same information by the U.S. mail, a private delivery service,
courier, facsimile, or voice. Although each of these methods has vulnerabilities, the transmitted information can only be compromised as a result of theft, fraud, or
other illegal activity. By transmitting this information the sender is indicating their acceptance of this risk. If you do not wish to accept this risk then you should not
choose to use this form.
PRIVACY ACT STATEMENT

Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act Statement serves to inform you of why the U.S. Department of Commerce (the Department), National Institute of
Standards and Technology (NIST) is requesting the information on this form.
AUTHORITY:

The National Institute of Standards and Technology Act, as amended, 15 U.S.C. 271 et seq. (which includes Title 15 U.S.C. 272) and section 12 of the Stevenson-Wydler
Technology Innovation Act of 1980, as amended, 15 U.S.C. 3710a. 5 U.S.C. App.—Inspector General Act of1978, § 2; 5 U.S.C. App.—Reorganization Plan of 1970, § 2; 13
U.S.C. § 2; 13 U.S.C. § 131; 15 U.S.C. § 272; 15 U.S.C. § 1151; 15 U.S.C. § 1501;15 U.S.C. § 1512; 15 U.S.C. § 1516; 15 U.S.C. § 3704b; 16 U.S.C. § 1431; 35 U.S.C. § 2; 42 U.S.C.
§ 3121 et seq.; 47 U.S.C. § 902; 50 U.S.C. App. § 2401 et seq.; E.O. 11625; 77 FR 49699 (Aug. 16, 1012).
PURPOSE:

The National Institute for Standards and Technology (NIST) is collecting this information for the registration of CNST NanoFab project applications.
ROUTINE USES:

The information solicited on this form may be made available as a “routine use” pursuant to 5 U.S.C. § 552a(a)(7) and (b)(3). The information may be made available
to other federal agencies to assist the Department in connection with NIST's management of the purposes stated above; or for other authorized routine uses.
A complete list of the routine uses can be found in the system of records notice associated with this form, “COMMERCE/DEPT-23: Information Collected Electronically
in Connection with Department of Commerce Activities, Events, and Programs. This system of records notice can be found on the Department's website at
https://www.osec.doc.gov/opog/privacyact/privacyact_sorns.html
CONSEQUENCES OF FAILURE TO PROVIDE INFORMATION:

Providing this information is voluntary. However, failure to provide the requested information may result in an inability for NIST to process, review, and/or act on such
requests. In limited circumstances, NIST may authorize the submission of the requested information via paper forms pursuant to the requirements in 15 CFR 748.1(d).

Submit