October 2018 - July 2019

Form Approved
OMB Number 0925-0698
Exp. Date 7/31/2020

Remote Site Request Form


Public reporting burden for this collection of information is estimated to average 20 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 (0925-0698). Do not return the completed form to this address.

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Please fill in the following information:

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Remote Site Liaison

Role of Remote Site Liaison

  • Assist in promotion and marketing of the course to other individuals at your site
  • Share all course announcements from the course coordinator to their remote site participants
  • Keep a record of all of the participants at their site who registered for the course

Once you submit this online Remote Site Request Form, it will then be reviewed by the IPPCR program coordinator and the course co-Directors. You will receive a message within one to two business weeks of your submission informing you if your request to set up a remote site has been approved or not approved.