NIMH Outreach Partnership Program Annual Meeting 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 Outreach Partnership Program Annual Meeting Registration

PURPOSE:
The NIMH Outreach Partnership Program is a nationwide initiative through which NIMH
supports 55 Outreach Partners - primarily nonprofit mental health organizations representing
every state, the District of Columbia, and Puerto Rico - to disseminate NIMH-supported
research and educational resources through their mental health outreach and education activities.
Attendance at an annual program meeting is required of all Outreach Partners. Registration data
is collected to ensure smooth logistics, including travel support of sponsored participants.

DESCRIPTION OF RESPONDENTS:

Representatives of NIMH Outreach Partner organizations, mostly nonprofit mental health
education and advocacy organizations that work at the state and local levels to educate the public
and other key constituencies about mental health.

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: Samantha Helfert, 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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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: Sponsored Outreach Partner

55

1

10/60

9 hours

Private Sector: Sponsored Non-Federal Presenter

8

1

10/60

1 hour

Private Sector: National Partner & other Non-sponsored participant

27

1

5/60

2 hours

90

90

Totals

Category of Respondent

Total Burden
Hours

Wage Rate*

12 hours

Total Burden
Cost

Private Sector: Sponsored Outreach Partner

9 hours

$27.26/hr

$245

Private Sector: National Partner & Other Non-sponsored Participant

2 hours

$27.26/hr

$55

Private Sector: Sponsored Non-Federal Presenter

1 hour

$93.12/hr

$93

Totals

12 hours

$393

*Cite source per bls.gov if applicable
https://www.bls.gov/oes/current/oes211091.htm; https://www.bls.gov/oes/current/oes291066.htm

FEDERAL COST: The estimated annual cost to the Federal government is: $6,223

Staff
Federal Oversight

Grade/Step

Salary

% of
Effort

Fringe (if
Total Cost to
applicable) Gov’t

NIMH Outreach Partnership Program Outreach Liaison

GS-13/10

$53.45/hr

20 hours

$1,069

NIMH Outreach Partnership Program Director

GS-14/7

$58.31/hr

10 hours

$583

Event Coordinator

$30.41/hr

40 hours

23.65%

$1,505

Web Developer

$25.46/hr

40 hours

23.65%

$1,258

Event Assistant

$24.36/hr

60 hours

23.65%

$1,808

Contractor Cost

Other Cost

2

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?
The respondent list represents the contacts at 55 current Outreach Partner organizations and 8 invited
presenters who are sponsored to participate in the meeting. In addition, respondents from National
Partner organizations and select NIMH staff are invited, but not all attend.

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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