Form Approved Through 10/31/2018
OMB No. 0925-0002
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Procedure for Submission of
Final Invention Statement and Certification (For Grant or Award)
Form HHS 568
A Final Invention Statement and Certification (Form HHS 568) shall be executed and submitted
within 90 days following the expiration or termination of a grant or award. The Statement shall
include all inventions which were conceived or first actually reduced to practice during the course
of work under the grant or award, from the original effective date of support through the date of
completion or termination. The Statement shall include any inventions reported previously for the
grant or award as part of a non-competing application. This reporting requirement is applicable to
grants and awards by Department of Health and Human Services in support of research.
The Final Invention Statement and Certification does not in any way relieve the person responsible
for the grant or award, or the institution, of the obligation to assure that all inventions are promptly
and fully reported directly to the National Institutes of Health, as required by terms of the grant or
award. Information regarding the reporting of inventions, including the reporting form to be
followed, may be obtained from the Office of Policy for Extramural Research Administration,
Division of Extramural Inventions and Technology Resources, 6705 Rockledge Drive MSC 7980,
Bethesda, Maryland 20892-7980, Telephone: (301) 435-1986.
The original of the completed Final Invention Statement and Certification is to be returned to the
awarding component that funded the grant or award. The entire grant or award number must appear
in the designated box on the form. The period covered by the Final Invention Statement is the
project period of the grant or award at a particular grantee institution. If no inventions were
involved, insert the word “None” in the first block under item Title of Invention. Each Statement
requires the signature of an institution official authorized to sign on behalf of the institution.
Public reporting burden for this collection of information is estimated to vary from 5 to 10 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 (0925-0002). Do not return the completed form to this addresses.
Privacy Act Statement. The NIH maintains application and grant records as part of a system of
records as defined by the Privacy Act: NIH 09-25-0036, Extramural Awards and Chartered
Advisory Committees (IMPAC 2), Contract Information (DCIS), and Cooperative Agreement
Information, HHS/NIH :
http://oma.od.nih.gov/ms/privacy/pa-files/0036.htm
.
HHS 568 (Rev. 06/15) — Instructions
