Generic Clearance Submission Template

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Request for Approval under the 
Generic Clearance for the “Conference, Meeting, Workshop, and 
Poster Session Registration Generic Clearance (OD)”
(OMB#: 0925-0740, Expiration Date: 07/31/2022)

 
TITLE OF INFORMATION COLLECTION:
NCI GISC Neuroendocrine Tumor Clinical Trials Planning Meeting Treatment in the Era of Peptide Receptor Radionuclide Therapy

PURPOSE:  
The purpose of this conference is to identify strategies for the treatment of patients with neuroendocrine tumors (NETs) in the era of peptide receptor radionuclide therapy (PRRT).

DESCRIPTION OF RESPONDENTS: 
Oncologists, nuclear medicine researchers, scientists, nurses, statisticians, clinical trialists, and advocates.

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:  Annette Mitchell

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
Individuals
47
1
         5/60
4
Totals
 
47

4


Category of Respondent
Total Burden
Hours
Hourly Wage Rate*
Total Burden Cost
Individuals
4
$45.80
$183.20
Total


$183.20
*Source of the mean Hourly Wage Rate is provided by the Bureau of Labor Statistics, Occupation title “Medical Scientists” 19-1040, https://www.bls.gov/oes/2018/May/oes_nat.htm#00-0000.

FEDERAL COST:  The estimated annual cost to the Federal government is $ 11,389.07.

Staff
Grade/Step
Salary**
% of Effort
Fringe 
(if applicable)
Total Cost to Gov’t
Federal Oversight





     Public Advisor
14/6
141,534
5%

$7,076.70






Contractor Cost




$2,066.87






Travel




$0
Other Cost




$2,245.50






Total




$ 11,389.07
**The salary in the table above is cited from https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/20Tables/html/DCB.aspx


If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions: N/A

The selection of your targeted respondents
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?											[  ] 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?


Administration of the Instrument
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

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.