Sub-study for 2019 Non Profit Forum

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: 2019 Nonprofit Forum Registration

PURPOSE: The purpose of this information collection is to collect general registrant information (e.g., name, institution, and contact information), breakout sessions attendance, and poster title and abstract submissions from the 2019 Nonprofit Forum attendees. Meeting attendees have the option to attend various breakout sessions and submit abstracts/posters of their organization’s efforts.

DESCRIPTION OF RESPONDENTS: Respondents are meeting registrants including National Institutes of Health (NIH), the Food and Drug Administration (FDA), industry and 75 different nonprofit organizations across the country who will attend the NIH sponsored 2019 Nonprofit Forum in the Neuroscience Center (6001 Executive Boulevard First Floor Conference Rooms) in Rockville, Maryland. The online registration form is similar for all meeting attendees and will automatically display additional questions regarding breakout session preferences. All meeting attendees have the option of submitting a poster/abstract (<300 words).

TYPE OF COLLECTION: (Check one)

[ ] Abstract [ ] Application

[x] 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 (includes potential poster abstract submitters)	200	1	20/60	67
Totals	200	200		67

Category of Respondent	Total Burden Hours	Wage Rate*	Total Burden Cost
Individual	67	$38.56	$2,583.52
Totals	67		$2,583.52

*Hourly wage rates for 19-1029 Biological Scientists is $38.56 (based on http://www.bls.gov/oes/current/oes191029.htm).

FEDERAL COST: The estimated annual cost to the Federal government is $18,476.49.

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight:
Health Science Policy Analyst	11/1	$68,036.00	20%		$13,607.20
Contractor Cost (optional):
Contractor 1		$12,313.00	15%		$1,846.95
Contractor 2		$6,044.67	50%		$3,022.34
Travel (optional)
Other Cost (optional)
Total					$18,476.49

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.

Federal staff are comprised of federal employees and/or contractors who support their agency’s contribution to the Nonprofit Forum and are self-identified at each agency.

For nonprofit organizations, lists of groups likely interested and/or invested in the Forum will be referenced. These lists are held by the NINDS communications office and recommendations from other federal agencies will be requested. For additional questions, please send a request to Jessica Corley ([email protected]).

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.

Screenshots of the online survey form are attached.

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