Request to Submit Manuscript for Publication (ARS-115)

CRIS Number:

Manuscript Title:

Manuscript Peer Reviewed: Yes No *First Formal Report Other than Abstract: Yes No

*Does the manuscript report CRADA research? Yes No If yes: Enter the CRADA No.: Has CRADA Cooperator Reviewed and Approved this Publication? Yes No

Submitter Name (Last, First, MI, suffix): Phone: Email:

Contact Scientist Name (Last, First, MI, suffix): Phone: Email: Fax:

Meeting name: Meeting location: Meeting dates:

Name of Journal or Publication:

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Cleared Indicates approval of all non-ARS authors for the Interpretive Summary, Abstract, and Affiliation to be released to the public. (Note: This field must be checked in order to approve the 115 to the next level.)

Journal or Equivalent: *Publication Type (choose one from list): Abstract Confidential until Published: Yes No Date submitted to Journal: Acceptance date: Previously Submitted: Yes No Journal URL (web site address if known): Reprint URL (web site address if known): Publication date: Hold from Tektran for Ott Review: Yes No Hold from Tektran: Until Published Permanently Never to be Published

Patent Information *Due to patent potential, is retention of intellectual property rights desired? Yes No (If unknown contact Patent Advisor.)

If Publication Type = Patent, Provision or PCT, complete the following fields: Serial/App. Number: Date Application Filed:

Additional Citation Information (e.g., volume number, page number, etc., if known):

Interpretive Summary (75 spaces/25 lines): Not required Attached

Technical Abstract (75 spaces/25 lines): Attached