Information Collection Request

Conference, Meeting, Workshop, and Poster Session Registration Generic Clearance (OD)

ICR 201602-0925-001 · OMB 0925-0740 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 1 The Cognition and Medical Image Perception Think Tank Registration Form (NCI) Form and Instruction New Available
Form 1 Workshop Registration and Abstract for Collaborations in Metabolomics Event (NCI) Form and Instruction New Repair queued
Form 1 DCCPS Fellows Symposium Submission (NCI) Form and Instruction New Repair queued
Form 1 Division of Cancer Control and Population Sciences and Division of Cancer Prevention 2019 New Grantee Workshop, November 21-22,2019 (NCI) Form and Instruction New Available
Form 1 2019 Hackathon Workshops Application (NLM) Form and Instruction New Available
Form 1 Frontiers in Light Microscopy - Multiscale Imaging: From Organelles to Organisms (NCI) Form and Instruction New Repair queued
Form 1 Center of Excellence in Chromosome Biology (CECB), Chromatin and Cell Fate Decisions in Development, Aging & Cancer Conference (NCI) Form and Instruction New Repair queued
Form 1 2019 Women-led Biodata Science Hackathon Application (NLM) Form and Instruction New Repair queued
Form 1 Outreach Partnership Program Annual Meeting Registration Form (NIMH) Form and Instruction New Available
Form 1 12th Annual Frontiers in Chemistry and Biology Interface Symposium (NCI) Form and Instruction New Available
Form 1 2019 Nonprofit Forum Registration (NINDS) Form New Available
Form 1 2019 Myalgic Encephalomyeliti/Chronic Fatigue Syndrome (ME/CFS) Young Investigators Travel Awards Workshop (NINDS) Form and Instruction New Available
Form 1 Scientific abstract collection for the 2019 High-Risk, High-Reward Research Symposium (OD) Form New Available
Form 1 Registration for Workshop to Facilitate Cancer Systems Epidemiology Research (NCI) Form New Available
Form 1 Application and registration information collection for the Mary Frances Picciano Dietary Supplement Research Practicum (DSRP) on May 29–31, 2019 at the Lister Hill Auditorium (NLM) Form New Repair queued
Form 1 Application and registration information collection for the Mary Frances Picciano Dietary Supplement Research Practicum (DSRP) on May 29–31, 2019 at the Lister Hill Auditorium (NLM) Form New Available
Form 1 2019 Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Principle Investigators (PI) Conference Registration (NINDS) Form and Instruction New Repair queued
Form 1 Non-profit organizations with interest in supporting research sign-up (NIDA) Form New Available
Form 1 RNA Biology workshop (NCI) Form New Repair queued
Form 1 5th NCI Pancreatic Cancer Symposium Form New Repair queued
Form 1 NIH Common Fund SPARC Program Abstract Collection for ISAN 2019 Meeting Form New Repair queued
Form 1 Specialized Programs of Research Excellence (SPORE) REVISED Contact Information Form (NCI) Form New Repair queued
Form 1 Registration and Abstract Submission for the NCI Cohort Consortium 2018 Annual Meeting (NCI) Form and Instruction New Available
Form 1 Specialized Programs of Research Excellence (SPORE) Contact Information Form (NCI) Form New Available
Form 1 Registration and Abstract Submission for Poster Session for Metabolomics Meeting Form and Instruction New Available
Form 1 NIMH Mental Health Services Research Conference Registration Form and Instruction New Repair queued
Form 1 Sandpit Workshop Form New Available
Form 1 Office of Intramural Training & Education (OITE) – How to Teach and Advise on Career Development Topics for the Next Generation of Biomedical Scientists: A Train-the-Trainers Event – Abstract Form New Repair queued
Form 1 Office of Intramural Training & Education (OITE) – How to Teach and Advise on Career Development Topics for the Next Generation of Biomedical Scientists: A Train-the-Trainers Event Form New Repair queued
Form 1 Scientific abstract collectrion for the 2018 High-Risk, High-Reward Research Symposium Form and Instruction New Available
Form 1 Application for NIH Support to Participate in NHLBI-funded Training Workshop Form New Available
Form 1 NIH Office of Intramural Training & Education (OITE) - International Opportunities Expo - Exhibitor Registration Form New Repair queued
Form 1 Office of Intramural Training & Education (OITE) - Community College Summer Enrichment Program (CCSEP) and College Summer Opportunities in Advanced Research (C-SOAR) Alumni Database Form New Available
Form 1 HINTS Workshop Sub-Study Form New Repair queued
Form 1 2018 Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Principle Investigators (PIs) Meeting Conference Registration Form New Available
Form 1 Sandpit Workshop Form and Instruction New Repair queued
Form 1 Health Disparities Research Institute (HDRI) Course Assessment Form New Available
Form 1 Office of Intramural Training & Education (OITE) – HiSTEP Alumni Database Form and Instruction New Available
Form 1 The National Institute of Neurological Disorders and Stroke (NINDS) Landis Award for Outstanding Mentorship Form and Instruction New Available
Form 1 Demographic Information Survey for Applicants to NIH Training and Fellowship Programs Form and Instruction New Available
Form 1 Demographic Information Survey on NIH Traninees/Fellows Form New Repair queued
Form 1 NIMH Outreach Partnership Program Annual Meeting Registration Form and Instruction New Available
Form 1 NIMH Computational Psychiatry Workshop Registration Form and Instruction New Available
Form 1 NIMH Global Mental Health Conference Registration (Private Sector) Form and Instruction New Repair queued
Form 1 NIMH Global Mental Health Conference Registration (Individuals) Form and Instruction New Repair queued
Form 1 Health Disparities Research Institute (HDRI) (NIMHD) Form and Instruction New Available
Form 1 Annual Norman P. Salzman Memorial Award and Symposium in Virology Form New Available
Form 1 2016 Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Principle Investigators' (PI) Meeting Conference Registration (NINDS) Form and Instruction New Available
Form 1 Annual Norman P. Salzman Memorial Award and Symposium in Virology Form New Repair queued
Form 1 Office of Intramural Training & Education (OITE) – Alumni Database for Former NIH Trainees Form and Instruction New Available
Form 1 NIMH Office Constituency Relations and Public Liaison (OCRPL) - Outreach and Engagement Activities Registration Form and Instruction New Available
Form 1 LRP Ambassador Sign-up and Consent Form New Available
Form 1 Application for NIH Support to Participate in Industry and Investor Showcase Events Form and Instruction New Repair queued
Form 1 NIH Office of Intramural Training & Education (OITE) – Graduate & Professional School Fair - Exhibitor Registration Form New Available
Form 1 Office of Intramural Training & Education (OITE) – Graduate Award Certificate Registration Form and Instruction New Repair queued
Form 1 NIH Office of Intramural Training & Education (OITE) – NIH Community College Day Registration Form New Available
Form 1 NIH Office of Intramural Training & Education (OITE) – MyOITE Account Registration Form New Available
Form 1 NIH Office of Intramural Training & Education (OITE) – Graduate & Professional School Fair - Student Registration Form New Repair queued
Sub-Study Template Example.doc Supplementary Document Uploaded 2016-05-26 Available
Attachment 2 example registration form (2).docx Supplementary Document Uploaded 2016-02-01 Available
Attachment 1 example of Poster abstracts.pdf Supplementary Document Uploaded 2016-02-01 Repair queued
Generic Clearance Currie 12-29-15.pdf Supplementary Document Uploaded 2016-02-01 Repair queued
2016-01555.pdf Supplementary Document Uploaded 2016-02-01 Repair queued
Abstracts Supporting Statement A-2016.docx Supporting Statement A Uploaded 2016-02-01 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
236265 The Cognition and Medical Image Perception Think Tank Registration Form (NCI) Form and Instruction New
236112 Workshop Registration and Abstract for Collaborations in Metabolomics Event (NCI) Form and Instruction New
236105 DCCPS Fellows Symposium Submission (NCI) Form and Instruction New
236102 Division of Cancer Control and Population Sciences and Division of Cancer Prevention 2019 New Grantee Workshop, November 21-22,2019 (NCI) Form and Instruction New
235935 2019 Hackathon Workshops Application (NLM) Form and Instruction New
235916 Frontiers in Light Microscopy - Multiscale Imaging: From Organelles to Organisms (NCI) Form and Instruction New
235836 Center of Excellence in Chromosome Biology (CECB), Chromatin and Cell Fate Decisions in Development, Aging & Cancer Conference (NCI) Form and Instruction New
235620 2019 Women-led Biodata Science Hackathon Application (NLM) Form and Instruction New
235603 Outreach Partnership Program Annual Meeting Registration Form (NIMH) Form and Instruction New
235491 12th Annual Frontiers in Chemistry and Biology Interface Symposium (NCI) Form and Instruction New
235302 2019 Nonprofit Forum Registration (NINDS) Form New
234905 2019 Myalgic Encephalomyeliti/Chronic Fatigue Syndrome (ME/CFS) Young Investigators Travel Awards Workshop (NINDS) Form and Instruction New
234818 Scientific abstract collection for the 2019 High-Risk, High-Reward Research Symposium (OD) Form New
234746 Registration for Workshop to Facilitate Cancer Systems Epidemiology Research (NCI) Form New
234162 Application and registration information collection for the Mary Frances Picciano Dietary Supplement Research Practicum (DSRP) on May 29–31, 2019 at the Lister Hill Auditorium (NLM) Form New
234157 Application and registration information collection for the Mary Frances Picciano Dietary Supplement Research Practicum (DSRP) on May 29–31, 2019 at the Lister Hill Auditorium (NLM) Form New
233713 2019 Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Principle Investigators (PI) Conference Registration (NINDS) Form and Instruction New
233239 Non-profit organizations with interest in supporting research sign-up (NIDA) Form New
233212 RNA Biology workshop (NCI) Form New
233181 5th NCI Pancreatic Cancer Symposium Form New
232991 NIH Common Fund SPARC Program Abstract Collection for ISAN 2019 Meeting Form New
232667 Specialized Programs of Research Excellence (SPORE) REVISED Contact Information Form (NCI) Form New
232577 Registration and Abstract Submission for the NCI Cohort Consortium 2018 Annual Meeting (NCI) Form and Instruction New
232449 Specialized Programs of Research Excellence (SPORE) Contact Information Form (NCI) Form New
231417 Registration and Abstract Submission for Poster Session for Metabolomics Meeting Form and Instruction New
230908 NIMH Mental Health Services Research Conference Registration Form and Instruction New
230872 Sandpit Workshop Form New
230501 Office of Intramural Training & Education (OITE) – How to Teach and Advise on Career Development Topics for the Next Generation of Biomedical Scientists: A Train-the-Trainers Event – Abstract Form New
230500 Office of Intramural Training & Education (OITE) – How to Teach and Advise on Career Development Topics for the Next Generation of Biomedical Scientists: A Train-the-Trainers Event Form New
230241 Scientific abstract collectrion for the 2018 High-Risk, High-Reward Research Symposium Form and Instruction New
230112 Application for NIH Support to Participate in NHLBI-funded Training Workshop Form New
230086 NIH Office of Intramural Training & Education (OITE) - International Opportunities Expo - Exhibitor Registration Form New
229702 Office of Intramural Training & Education (OITE) - Community College Summer Enrichment Program (CCSEP) and College Summer Opportunities in Advanced Research (C-SOAR) Alumni Database Form New
228815 HINTS Workshop Sub-Study Form New
228777 2018 Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Principle Investigators (PIs) Meeting Conference Registration Form New
228515 Sandpit Workshop Form and Instruction New
227469 Health Disparities Research Institute (HDRI) Course Assessment Form New
227439 Office of Intramural Training & Education (OITE) – HiSTEP Alumni Database Form and Instruction New
227341 The National Institute of Neurological Disorders and Stroke (NINDS) Landis Award for Outstanding Mentorship Form and Instruction New
226444 Demographic Information Survey for Applicants to NIH Training and Fellowship Programs Form and Instruction New
226289 Demographic Information Survey on NIH Traninees/Fellows Form New
226280 NIMH Outreach Partnership Program Annual Meeting Registration Form and Instruction New
226222 NIMH Computational Psychiatry Workshop Registration Form and Instruction New
225994 NIMH Global Mental Health Conference Registration (Private Sector) Form and Instruction New
225993 NIMH Global Mental Health Conference Registration (Individuals) Form and Instruction New
225774 Health Disparities Research Institute (HDRI) (NIMHD) Form and Instruction New
223756 Annual Norman P. Salzman Memorial Award and Symposium in Virology Form New
223399 2016 Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Principle Investigators' (PI) Meeting Conference Registration (NINDS) Form and Instruction New
223380 Annual Norman P. Salzman Memorial Award and Symposium in Virology Form New
223054 Office of Intramural Training & Education (OITE) – Alumni Database for Former NIH Trainees Form and Instruction New
222961 NIMH Office Constituency Relations and Public Liaison (OCRPL) - Outreach and Engagement Activities Registration Form and Instruction New
222744 LRP Ambassador Sign-up and Consent Form New
222512 Application for NIH Support to Participate in Industry and Investor Showcase Events Form and Instruction New
222356 NIH Office of Intramural Training & Education (OITE) – Graduate & Professional School Fair - Exhibitor Registration Form New
222276 Office of Intramural Training & Education (OITE) – Graduate Award Certificate Registration Form and Instruction New
222176 NIH Office of Intramural Training & Education (OITE) – NIH Community College Day Registration Form New
222168 NIH Office of Intramural Training & Education (OITE) – MyOITE Account Registration Form New
222100 NIH Office of Intramural Training & Education (OITE) – Graduate & Professional School Fair - Student Registration Form New
ICR Details
0925-0740 201602-0925-001
Historical Active
HHS/NIH
Conference, Meeting, Workshop, and Poster Session Registration Generic Clearance (OD)
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 05/26/2016
Retrieve Notice of Action (NOA) 02/02/2016
All GenICs submitted under this Generic will have an accompanying memo (see template in supplementary documents) and instrument.
  Inventory as of this Action Requested Previously Approved
05/31/2019 36 Months From Approved
34,500 0 0
26,625 0 0
390,415 0 0

The National Institutes of Health (NIH) directly sponsors, organizes, and conducts research-related activities such as conferences, workshops, meetings, poster sessions, and training courses. These activities are designed to be relevant to the current state of research in a given field or to the current stage of participants’ research projects or careers, and other resource limitations also determine the number of possible participants. In order for such activities to be timely and to optimally use available resources to address needs and opportunities within the research community, it is necessary for NIH to have a means to register and select the most appropriate participants, according to the type or purpose of a given activity. NIH is requesting a 3 year generic clearance to provide a quick and efficient process to create registration forms for NIH sponsored conference, meetings, workshops meetings, poster sessions, presentations and panels.

US Code: 42 USC 258 Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  80 FR 45541 07/30/2015
81 FR 4315 01/26/2016
No

58
IC Title Form No. Form Name
NIMH Office Constituency Relations and Public Liaison (OCRPL) - Outreach and Engagement Activities Registration 1 OCRPL Outreach and Engagement Activities Registration Form
Demographic Information Survey on NIH Traninees/Fellows 1 EDI Demographic Form for NIH Trainees and Fellows
The National Institute of Neurological Disorders and Stroke (NINDS) Landis Award for Outstanding Mentorship 1 Landis Instrument
Office of Intramural Training & Education (OITE) - Community College Summer Enrichment Program (CCSEP) and College Summer Opportunities in Advanced Research (C-SOAR) Alumni Database 1 CCSEP-CSOAR-Alumni
2019 Nonprofit Forum Registration (NINDS) 1 NINDS Nonprofit Forum Registration Questions
NIH Office of Intramural Training & Education (OITE) – MyOITE Account Registration 4, 3, 2, 1 MyOITE Trainee ,   MyOITE-Staff ScientistClinician ,   MyOITE-OtherStaffNIH ,   MyOITE-Guest
LRP Ambassador Sign-up and Consent 1 LRP Ambassador Sign-up Form
Annual Norman P. Salzman Memorial Award and Symposium in Virology 1 Registration Form
Health Disparities Research Institute (HDRI) (NIMHD) 1 HDRI Application 2017
Office of Intramural Training & Education (OITE) – HiSTEP Alumni Database 1 OMBFT- HiSTEP- Alumni
2018 Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Principle Investigators (PIs) Meeting Conference Registration 1, 3, 2 General Attendees Registration ,   Investigator Registration and Abstract Path ,   Trainee Registration and Abstract Path
NIH Office of Intramural Training & Education (OITE) - International Opportunities Expo - Exhibitor Registration 1 OITE International Expo Exhibitor Registration
Registration and Abstract Submission for Poster Session for Metabolomics Meeting 1, 2 COMETS Abstract submission ,   COMETS Registration site
2019 Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Principle Investigators (PI) Conference Registration (NINDS) 2, 1, 3 Scientist registration and abstract submission ,   Trainee registration and abstract submission ,   General attendee registration
Application and registration information collection for the Mary Frances Picciano Dietary Supplement Research Practicum (DSRP) on May 29–31, 2019 at the Lister Hill Auditorium (NLM) 1 ODS DSRP Application 2019
Annual Norman P. Salzman Memorial Award and Symposium in Virology 1 Attachment 1 Abstract Application
NIMH Computational Psychiatry Workshop Registration 1 NIMH Computational Psychiatry Workshop Registration Form
NIMH Outreach Partnership Program Annual Meeting Registration 1, 1, 1 OPP Annual Meeting- Sponsored Presenters Registration Form Data ,   OPP Annual Meeting- Sponsored Participants Registration Form Data ,   OPP Annual Meeting- Non-Sponsored Participants Registration Form Data
Application for NIH Support to Participate in NHLBI-funded Training Workshop 1 Saunders-Watkins 2018 Application
Frontiers in Light Microscopy - Multiscale Imaging: From Organelles to Organisms (NCI) 1 Registration Page
2019 Hackathon Workshops Application (NLM) 1 2019 Hackathon application instrument
Center of Excellence in Chromosome Biology (CECB), Chromatin and Cell Fate Decisions in Development, Aging & Cancer Conference (NCI) 1, 2 Abstract page ,   Registration page
DCCPS Fellows Symposium Submission (NCI) 1, 2 Registration and Abstract Submission Form screenshot ,   Mentor of the Year award form screenshot
NIH Office of Intramural Training & Education (OITE) – Graduate & Professional School Fair - Student Registration 1, 2 Graduate and Professional School Fair Student Registration- NIH ,   Graduate and Professional School Fair Student Registration- Non NIH
NIH Office of Intramural Training & Education (OITE) – NIH Community College Day Registration 1, 2 Individual Student Registration ,   Faculty Registration
NIH Office of Intramural Training & Education (OITE) – Graduate & Professional School Fair - Exhibitor Registration 1 Graduate and Professional School Fair Exhibitor Registration Collection
Office of Intramural Training & Education (OITE) – Alumni Database for Former NIH Trainees 1 OMBFT Alumni Database Registration Collection
Health Disparities Research Institute (HDRI) Course Assessment 1 HDRI Assessment
NIMH Mental Health Services Research Conference Registration 1, 2 MHSR Abstract Submission form ,   MHSR Participant Registration form
Registration and Abstract Submission for the NCI Cohort Consortium 2018 Annual Meeting (NCI) 1 Cohort Consortium Form
Specialized Programs of Research Excellence (SPORE) REVISED Contact Information Form (NCI) 1 Revised SPORE
5th NCI Pancreatic Cancer Symposium 2, 1 Attendee Registration ,   Abstract Application
2019 Myalgic Encephalomyeliti/Chronic Fatigue Syndrome (ME/CFS) Young Investigators Travel Awards Workshop (NINDS) 1 How to Apply for Travel Award Form
RNA Biology workshop (NCI) 1 Registration Screenshot
Scientific abstract collection for the 2019 High-Risk, High-Reward Research Symposium (OD) 1 HRHR Symposium abstract submission
Registration for Workshop to Facilitate Cancer Systems Epidemiology Research (NCI) 1 Registration Epi Research Workshop
Outreach Partnership Program Annual Meeting Registration Form (NIMH) 1 2019 OPP Registration Form and Questions
Workshop Registration and Abstract for Collaborations in Metabolomics Event (NCI) 1 Registration & Abstract screenshot
The Cognition and Medical Image Perception Think Tank Registration Form (NCI) 1 Cognitive Think Tank Registration Form
Office of Intramural Training & Education (OITE) – Graduate Award Certificate Registration 1 Award Certificate Registration Collection
Office of Intramural Training & Education (OITE) – How to Teach and Advise on Career Development Topics for the Next Generation of Biomedical Scientists: A Train-the-Trainers Event – Abstract 1 OITE TrainTrainers - Abstract
Demographic Information Survey for Applicants to NIH Training and Fellowship Programs 1 EDI Demographic Form of Applicants to NIH Training and Fellowship Program Survey
Scientific abstract collectrion for the 2018 High-Risk, High-Reward Research Symposium 1 HRHR Symposium Abstract Submission Page
Non-profit organizations with interest in supporting research sign-up (NIDA) 1 Sign-Up Form
12th Annual Frontiers in Chemistry and Biology Interface Symposium (NCI) 1, 2 Registration submission page ,   Abstract submission page
Office of Intramural Training & Education (OITE) – How to Teach and Advise on Career Development Topics for the Next Generation of Biomedical Scientists: A Train-the-Trainers Event 1, 2 OITE- Train Trainers - Interest ,   OITE Train Trainers - Registration
Specialized Programs of Research Excellence (SPORE) Contact Information Form (NCI) 1 TRP Contact Information Form
NIH Common Fund SPARC Program Abstract Collection for ISAN 2019 Meeting 1 SPARC at ISAN 2019 Abstract Management Screenshot
Application and registration information collection for the Mary Frances Picciano Dietary Supplement Research Practicum (DSRP) on May 29–31, 2019 at the Lister Hill Auditorium (NLM) 1 ODS DSRP Registration
2019 Women-led Biodata Science Hackathon Application (NLM) 1 Women-led Hackathon Application instrument
Division of Cancer Control and Population Sciences and Division of Cancer Prevention 2019 New Grantee Workshop, November 21-22,2019 (NCI) 1, 2 new Grantee Wkshop Registration/Abstract ,   Assessment Form
Application for NIH Support to Participate in Industry and Investor Showcase Events 1 Application to Participate in Industry and Investor Showcase Events
2016 Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Principle Investigators' (PI) Meeting Conference Registration (NINDS) 2, 1, 3 Investigator or trainee for a federally funded BRAIN project (abstract submitters) ,   Investigator or trainee for a federally funded BRAIN project ,   Other or other BRAIN-related investigator or trainee
NIMH Global Mental Health Conference Registration (Private Sector) 1 GMH Conference Registration Form
NIMH Global Mental Health Conference Registration (Individuals) 1 GMH Conference Registration Form
Sandpit Workshop 1 Sandpit Research Call 2018
HINTS Workshop Sub-Study 1, 2 Abstract Submission Screenshot ,   Registration Screenshot
Sandpit Workshop 1 2018 CRUNK-NCI sandpit research call

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 34,500 0 0 34,500 0 0
Annual Time Burden (Hours) 26,625 0 0 26,625 0 0
Annual Cost Burden (Dollars) 390,415 0 0 390,415 0 0
Yes
Miscellaneous Actions
No
This is a new information collection request.

$1,937
No
No
No
No
No
Uncollected
Mikia Currie 3014350941

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/02/2016