NIMH OCRPL Outreach and Engagement Activities Registration

Request for Approval under the “Conference, Meeting, Workshop, and Poster
Session Registration Generic Clearance (OD)”
(OMB#: 0925-0740 Exp Date: 05/2019)
TITLE OF INFORMATION COLLECTION:
NIMH Office of Constituency Relations and Public Liaison (OCRPL) - Outreach and
Engagement Activities Registration

PURPOSE:
The National Institute of Mental Health (NIMH) Office on Constituency Relations and Public Liaison (OCRPL) supports
the Institute’s mission by strengthening the public health impact of NIMH-supported research through effective and
efficient outreach that seeks to assure dissemination of research findings to key stakeholders. Through the use of targeted
initiatives, programs and activities which encourage two-way communication, OCRPL sustains existing partnerships and
works to build new relationships with groups and organizations with an interest in NIMH’s mission or programs.
NIMH convenes representatives of patient and family advocacy organizations, professional groups, and select non-profit
groups to share the latest research advances and related developments and foster dialogue on the future path and
directions of research. Registration information collected is used to develop a participant list and to distribute related
materials after the meeting.

DESCRIPTION OF RESPONDENTS:

Participants in NIMH/OCRPL outreach and engagement activities are representatives of national
patient and family advocacy organizations, professional groups, and non-profit organizations
who have an interest in NIMH research.

TYPE OF COLLECTION: (Check one)
Abstract

Application

✔ Registration Form

Other:

CERTIFICATION:
I certify the following to be true:
1. The collection is voluntary.
2. The collection is low-burden for respondents and low-cost for the Federal Government.
3. The collection is non-controversial and does not raise issues of concern to other federal
agencies.
Name: Phyllis Ampofo, MPH; [email protected]; 301-443-8530
To assist review, please provide answers to the following question:
Personally Identifiable Information:
1. Is personally identifiable information (PII) collected?

✔ Yes

No

2. If Yes, is the information that will be collected included in records that are subject to the
Privacy Act of 1974?
No
✔ Yes

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Gifts or Payments:
Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to
participants?
Yes
✔ No
Amount:
Explanation for incentive: (include number of visits, etc.)

ESTIMATED BURDEN HOURS and COSTS
Category of Respondent

No. of Respondents

No. of Responses per
Respondent

Time per
Response
(in hours)

Total
Burden
Hours

Private Sector

40

1

5/60

3

Individual (faculty participants)

5

1

5/60

1

Individual (federal contractor participants)

15

1

5/60

1

65

65

n/a

5

Totals

Category of Respondent

Total Burden
Hours

Wage Rate*

Total Burden
Cost

Private Sector

3

$59.71/hr

$179.13

Individual (faculty participants)

1

$44.73/hr

$44.73

Individual (federal contractor participants)

1

$60.87/hr

$60.87

5

n/a

$284.73

Totals
*Cite source per bls.gov if applicable

The federal participant salary was estimated based upon the locality pay for the DC-MD-VA-WV-PA salary table at
https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2016/DCB.pdf. Participant wage rate data is from the Top
Executives (11-1000) and Psychologist, All Other (19-3039) categories at http://www.bls.gov/oes/current/oes_nat.htm#00-0000

FEDERAL COST: The estimated annual cost to the Federal government is: $2,148.57

Staff
Federal Oversight

Grade/Step

Salary

% of
Effort

Fringe (if
Total Cost to
applicable) Gov’t

Program Specialist

GS-14/SO6

$127,036

.01

$1,270.36

Program Analyst

GS-12/SO5

$87,821

.01

$878.21

Contractor Cost
Travel
Other Cost
TOTAL

$2,148.57

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The selection of targeted respondents
1. Do you have a customer list or something similar that defines the universe of potential
respondents and do you have a sampling plan for selecting from this universe?
No
✔ Yes
If the answer is yes, please provide a description of both below (or attach the sampling plan)? If
the answer is no, please provide a description of how you plan to identify your potential group of
respondents and how you will select them?
NIMH/OCRPL maintains a list of organizations that have participated in previous NIMH/OCRPL
outreach and engagement activities. Invitations to register are sent to this distribution list.

Administration of the Instrument
1. How will you collect the information? (Check all that apply)

✔ Web-based or other forms of Social Media
Telephone
In-person
Mail

✔ Survey form
Chart Abstraction
Other, Explain
2. Will interviewers, facilitators, or research coordinators be used?

Yes

✔ No

Please make sure that all instruments, instructions, and scripts are submitted with the
request.

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