NIMH Computational Psychiatry Workshop 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 Computational Psychiatry Workshop Registration

PURPOSE:
Collect preliminary information from participants of the NIMH Computational Psychiatry
Workshop.

DESCRIPTION OF RESPONDENTS:

Participants of the workshop include academic and federal researchers in the field of
computational psychiatry.

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: Megan Kinnane, NIMH
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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Last Updated: August 2016

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

Private Sector (Not-for-profit)

40

1

40

40

Totals

Category of Respondent

Total Burden
Hours

Private Sector (Not-for-profit)

No. of Responses per
Respondent

Wage Rate*

3 hours

Totals

Time per
Response
(in hours)

Total
Burden
Hours

5/60

3 hours

3 hours

Total Burden
Cost

$38.11/hr

$114

3 hours

$114

*Cite source per bls.gov if applicable
https://www.bls.gov/oes/2014/may/oes191099.htm

FEDERAL COST: The estimated annual cost to the Federal government is: $276

Staff
Federal Oversight
Health Science Administrator

Grade/Step
14/9

Salary
$137,926

% of
Effort
.2%

Fringe (if
Total Cost to
applicable) Gov’t

$276

Contractor Cost
Travel
Other Cost

2

Last Updated: August 2016

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?

Potential respondents are researchers in the field of computational psychiatry identified by the
workshop organizing committee.
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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Last Updated: August 2016