SGMRO Conference template

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

(OMB#: 0925-0740 Exp Date: 07/31/2022)

T ITLE OF INFORMATION COLLECTION: Registration information collection for the NIH Sexual & Gender Minority Research Office (SGMRO) – Regional Workshop

PURPOSE:

The Sexual & Gender Minority Research Office (SGRMO) at the National Institutes of Health (NIH) is offering a one-day grantspersonship opportunity. The purpose of the Sexual and Gender Minority (SGM) Health Research Regional Workshop is to increase the understanding of the NIH structure and processes among researchers and potential researchers who are interested in SGM health. This meeting will also develop goals to mentor relationships within the extramural research community among promising or aspiring researchers in SGM health and those who conduct it. It will also enhance the capacity to design, conduct, and report on SGM research and provide researchers with the opportunity to interact with NIH staff closer to their home institutions. Additional details about the SGMRO and its programming may be found by visiting: https://dpcpsi.nih.gov/sgmro

DESCRIPTION OF RESPONDENTS:

The workshop is open to university faculty, postdoctoral fellows, graduate students, researchers, science administrators, and advocacy group in SGM health-related disciplines, such as addiction, aging, cardiovascular disease, chronic diseases, diabetes, infectious diseases, mental health, and other biomedical research disciplines related to the NIH mission. Primary candidates are full-time academic faculty, doctoral students, postdocs, administrators, and advocacy groups. The workshop is limited to approximately 100 attendees and we estimate that we will receive about 100 applications.

TYPE OF COLLECTION: (Check all that applies)

[ ] 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: Irene Avila, PhD ([email protected]; 301-594-9701)

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

Personally Identifiable Information:

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

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] 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
Private Sector (not-for-profit)	100	1	5/60	8
Totals		100		8

Category of Respondent	Total Burden Hours	Wage Rate*	Total Burden Cost
Private Sector (not-for-profit)	8	$27.60/hr	$221
Totals			$221

* https://www.bls.gov/oes/2018/may/oes_nat.htm#19-0000

FEDERAL COST: The estimated annual cost to the Federal government is $1,567.60

Staff	Grade/Step	Salary*	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Assistant Director	14/3	129,404	0.15%		$194.00
Contractor Cost
Website Developer		$68.68/hr	20 hours		$1,373.60
Travel
Other Cost
Total					$1,567.60

*the Salary in table above is cited from https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2018/DCB.pdf

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?

The SGMRO has a listserv with compiled emails of specific individuals and groups that will be sent an email that includes information about the regional workshop, the website link, an invitation to register and a flyer to pass along the email to others that may be interested.

The SGMRO will also publish a NIH Notice of Special Interest (NOSI) to announce and provide information about the regional workshop, which will include an invitation to register and the website link. The NOSI will help the SGMRO reach the research and academic audience.

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.

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