Sub-Study Template

Request for Approval under the “Conference, Meeting, Workshop, and Poster Session Registration Generic Clearance (OD)”

(OMB#: 0925-0740 Exp Date: 05/2019)

T ITLE OF INFORMATION COLLECTION: The National Institute of Neurological Disorders and Stroke (NINDS) Landis Award for Outstanding Mentorship

PURPOSE: The purpose of this information collection is to collect nominations from current or former research trainees, and to collect additional information from eligible nominees for the NINDS Landis Award for outstanding mentorship. The nomination form will collect information about the nominators, such as their name, current position, institution, and their relationship to the nominee, as well as description of why the nominee is an exceptional mentor. The collected information will be used to select eligible nominees (those nominated by two or more former or current trainees) for NINDS to consider for the mentorship award. NINDS will then send an email request to the eligible nominees to collect additional information, including a statement of mentoring approach and philosophy, a CV, a list of current and former trainees and descriptions of their accomplishments, and letters of recommendation. This additional information will help NINDS make award recommendations to the NINDS Council and determine awardees.

DESCRIPTION OF RESPONDENTS: 1) “Nominators” – Respondents to the nomination form are researchers who have or have had mentors who are NINDS grantees. They are undergraduate students, post-bacs, graduate students, post-doc researchers, or early stage investigators in neuroscience research. 2) “Nominees” – Respondents to the email request for additional supporting information are a small pool of eligible nominees who have been nominated for the mentorship award by two or more former or current trainees. These respondents are tenure-track or equivalent faculty members who hold an active NINDS grant.

TYPE OF COLLECTION: (Check one)

[ ] Abstract [x] 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: Sophia Jeon, Ph.D. Health Science Policy Analyst, NINDS OSPP

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [x] Yes [ ] No

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

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [x] 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
Individual: researchers who are “nominators”	100	1	15/60	25
Individual: researchers who are “nominees”	50	1	45/60	38
Totals	150	150		63

Category of Respondent	Total Burden Hours	Wage Rate*	Total Burden Cost
Individual: researchers who are “nominators”	25	$37.42	$935.50
Individual: researchers who are “nominees”	38	$37.42	$1421.96
Totals	50		$2357.46

* Hourly wage rates for 19-1029 Biologic Scientist is $37.42 (based on https://www.bls.gov/oes/current/oes191029.htm)

FEDERAL COST: The estimated annual cost to the Federal government is $6,673

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
NINDS Training Office staff	GS-15/Step 10	$161,900	1%		$1,619
NINDS Training Office staff	GS-13/Step 1	$94,796	1%		$948
NINDS Training Office staff	GS-12/Step 3	$85,035	1%		$850
NINDS Program Director	GS-15/Step 1	$131,767	0.75%		$988
NINDS Program Director	GS-14/Step 5	$126,958	0.75%		$952
NINDS Program Director	GS-14/Step 5	$126,958	0.75%		$952
Contractor Cost
Web management team		$36,400	1%		$364
Travel
Other Cost
Total					$6,673

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? [x] Yes [ ] No

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?

Respondents to the nomination form are undergraduate students, post-bacs, graduate students, post-doc researchers, or early stage investigators in neuroscience research who currently are working or used to work for the nominee. The NINDS Landis Award for Outstanding Mentorship will be widely advertised to the neuroscience research community and published as a notice. NINDS will also send an email out to a list of current training grantees (about 200 trainees who are NINDS F awardees) to advertise the NINDS Landis Award and invite them to nominate exceptional mentors. NINDS will then select the eligible nominees who have been nominated for the mentorship award by two or more former or current trainees and ask them to submit additional information via email. The respondents to the email are tenure-track or equivalent faculty members who have been nominated more than once, and hold an active NINDS R01, R35, P01, or P50 with at least one year left on their grant at the time of award.

We will not sample the respondent population, but an estimated total of 250 researchers are expected as a potential universe of respondents as 200 trainees will receive invitations to fill out the nomination form while about 50 mentors will be selected as nominees eligible for the award. Out of this population, only those who wish to nominate mentors will be filling out the nomination form, and the eligible nominees who have been nominated twice or more will submit additional information via email.

Administration of the Instrument

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

[x] 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 [x] No

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

Instrument #1 – screenshot of the online nomination form

Instrument #2 – instruction email to submit additional supporting information

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