Application for Peer Grant Reviewers

Form Approved
OMB No. 0930-0255
Expires: August 31, 2016

Public reporting burden for this collection of information is estimated to average 1.5 hours 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to:

SAMHSA Reports Clearance Officer
Paperwork Reduction Project (0930-0255)
1 Choke Cherry Road
Room 3-1053
Rockville, Maryland 20857

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. The OMB control number for this project is 0930-0255.

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Reviewer Contact Information
NOTE: You must supply a valid email address for either your Home email account or Work email (space provided below) or we may not be able to contact you.
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Reviewer Information and Expertise

You may upload your résumé in the following formats: TXT, RTF, ODF, PDF, DOC, DOCX
You may upload your document in the following formats: TXT, RTF, ODF, PDF, DOC, DOCX
Last Updated: 02/04/2014