Study Request - Myofascial Pain HEAL Workshop

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

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

TITLE OF INFORMATION COLLECTION:

NIH HEAL Initiative℠ Workshop -- Quantitative Evaluation of Myofascial Tissues: Potential Impact for Musculoskeletal Pain Research

PURPOSE:

This Workshop will present in-depth analyses of the state of science of myofascial pain, current usage of technologies (e.g., methodologies) and their limitations, potential current technologies to be adapted for myofascial pain biomarker imaging or recording, and potential emerging technologies and methodologies.

DESCRIPTION OF RESPONDENTS:

NIH Scientists, Researchers, PIs, and the general public

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: Wen Chen, Ph.D., Branch Chief for Basic and Mechanistic Research, NCCIH Division of Extramural Research

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

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 (Registration)	250	1	10/60	42
Totals		250		42

Category of Respondent	Total Burden Hours	Hourly Wage Rate*	Total Burden Cost
Individuals	42	$45.80	$1,923.60
Total			$1923.60

*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 $2,708.00

Staff	Grade/Step	Salary**	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Branch Chief	15/7	$170,800	1%		$1,708.00
Contractor Cost					$1,000
Travel					0
Other Cost					0
Total					$2,708.00

**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

The selection of your 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? [ ] Yes [ X ] 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 website for the workshop will be posted by NCCIH to solicit interest from scientific investigators, research fellows and researchers, and any public participants interested in the state of science of myofascial pain, current usage of technologies (e.g., methodologies) and their limitations, potential current technologies to be adapted for myofascial pain biomarker imaging or recording, and potential emerging technologies and methodologies. Professional organizations will be informed by NCCIH of the workshop.

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.

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