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Submit a Nomination

Please provide as much information as possible so we can process your request and respond to you regarding your nomination.
If you wish to find more information on a substance or test method but do not want to make a nomination now, contact us.

OMB#: 0925-0766 Exp Date: 04/2023

Collection of this information is authorized by The Public Health Service Act, Section 411 (42 USC 285a). Rights of study participants are protected by The Privacy Act of 1974. Participation is voluntary, and there are no penalties for not participating or withdrawing from the study at any time. Refusal to participate will not affect your benefits in any way. The information collected in this study will be kept private to the extent provided by law. Names and other identifiers will not appear in any report of the study. Information provided will be combined for all study participants and reported as summaries. You are being contacted on-line to complete this instrument so that we can improve the website.

Public reporting burden for this collection of information is estimated to average no more than 5 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 (0925-0766). Do not return the completed form to this address.

Note: denotes required information.

Your Contact Information

Tips

Your contact information will only be used if we need to contact you concerning your submission. It will not be shared with external parties.

Your Nomination Input

Tips

  • Check the types of nomination that best fit your request. Use the links by the check boxes to learn about the different types of NTP nominations.
  • Describe specific issues or facts that prompt nomination of this substance, issue or model for study.
  • Describe activities or uses of materials that you feel may result in a potential health hazard. For example, Are you concerned about a particular product or exposure by food, water, or air? Are exposures continual, occasional, or infrequent?
  • Provide any references or descriptions of related sources.

Additional Information

Tips

The following information needs to be applied only if it is available.

The CASRN is the identifier assigned to each chemical by the Chemical Abstract Service. The registry number is unique for each chemical.

Attach any Supporting Files

Tips

The following file types are accepted by NTP:

  • PDF
  • Text Document
  • MS Office (Excel, Power Point or Word)
Submit the form.