NIH Leave Bank recipient application

• Fax Cover Sheet (NIH 2941)
• Application  (NIH 2940)
• Authorization to Disclose Information (NIH 2923)
• Medical Documentation Request
• Recipient Application Checklist

Other resources

• Policies and Procedures
• Terms
• Leave Bank Membership Video
• Donate to the Leave Bank Video
• Informational Videos
  • What is the NIH Leave Bank & How do I Join?
  • How do I Become a Leave Bank Recipient?
  • How do I Donate to the Leave Bank?
• Comparing: Leave Bank and VLTP
• Leave Bank Recipient Success Stories
• FAQs
  • Leave Bank
  • Leave Share Programs

Questions

Please visit our Leave Bank homepage for more information.

For questions, email LeaveBank@od.nih.gov or call 301-443-8393.