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**IC Inter/Intra Transfer Request**

**(use for NIH sponsored J-1 Exchange Visitors only)**

**INSTRUCTIONS:** This form should be completed by the **new**
Institute/Center (IC) lab wishing to transfer a J-1 Exchange Visitor
from one NIH IC lab to another. This form, along with the usual IC
transfer paperwork, should be sent to DIS at least 2-3 months
[before]{.underline} the effective date of transfer. A reminder on the
transfer paperwork requirements can be found on our Renewal/IC Transfer
checklists, located on our forms page at:
<http://dis.ors.od.nih.gov/forms/01_forms.html>

The J-1 Exchange Visitor Program allows for movement as necessary to
facilitate the J-1 Exchange Visitor's research objectives. In order to
comply with this requirement, the releasing IC sponsor must verify that
the research described below by the new IC is a continuation of the
research objectives originally started at NIH.

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**NEW IC SPONSOR:**

Proposed Effective date of Transfer:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of J-1 Exchange Visitor:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Description of research activity at new lab:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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I confirm that the above description is correct:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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# Signature Name of New Lab Sponsor Date

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RELEASING IC SPONSOR:

##  

Please review the description of proposed research activities for the
above J-1 Exchange Visitor:

1\. Do you agree that the above description is consistent with the J-1
Exchange Visitor's original research objective?

**\_\_\_\_\_\_\_\_ Yes \_\_\_\_\_\_\_\_ No**

2\. Do you have any objections to the transfer? **\_\_\_\_\_\_\_\_ Yes
\_\_\_\_\_\_\_\_ No**

**If you answered "No" to number 1, and/or "Yes" to number 2, please
provide additional comments:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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# Signature Name of Releasing Lab Sponsor Date

**Submit this form and transfer paperwork via [HAND-CARRY]{.underline}
to: Division of International Services /ORS**

*(NOTE: using hand-carry ensures delivery to DIS. DIS is not* **31
Center Drive, MSC 2028**

*responsible for lost packages. Lost or misdelivered* **Building 31, Rm
B2B07**

*packages are not ground for DIS to expedite processing!)* **Bethesda,
MD 20892-2028**