sub-study for ALS Stretegic Workshop

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

(OMB#: 0925-0740 Exp Date: 09/2025)

TITLE OF INFORMATION COLLECTION: ALS Strategic Plan Workshop Registration (NINDS)

PURPOSE: The purpose of this information collection is to collect general registrant information for individuals who will participate in the ALS Strategic Plan Workshop held by NINDS. The information will be used to provide meeting details and links to attendees and for program planning purposes. NINDS is committed to promoting a diverse research workforce and to including diverse participants at this workshop. To allow staff to determine whether participants at the workshop represent diverse groups and backgrounds, the registration form gives registrants an opportunity to share demographic information, which will be aggregated for internal NINDS use and ongoing program improvement purposes only.

DESCRIPTION OF RESPONDENTS: Respondents are members of the public, media, members of congress, patient/advocacy groups, clinicians, investigators and associated scientific staff from academic and private institutions around the country, as well as federal staff (primarily NIH and FDA).

TYPE OF COLLECTION: (Check one)

[ ] Abstract [ ] Application

[ ] Challenges and Competition

[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:_Cara Long, Ph.D., 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
Individuals	700	1	5/60	58
Totals		700	5/60	58

COST TO RESPONDENT

Category of Respondent	Total Burden Hours	Wage Rate*	Total Burden Cost
Individuals	58	43.22	2506.76
Totals			2506.76

*Hourly wage rates for “Academic or independent investigator” 19-1029 Biological Scientists is $43.22 (based on http://www.bls.gov/oes/current/oes191029.htm).

FEDERAL COST: The estimated annual cost to the Federal government is _$859.68_____

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Health Science Policy Analyst	13/1	106,823	2.5%		$267
Contractor Cost
		130,250	2.5%		592.68
Travel
Other Cost
Total					$859.68

*the Salary in table above is cited from https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2022/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? [] 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?

There is not a comprehensive list of all potential registrants. We aim to reach as many as possible individuals that may be interested and want to engage on this topic, primarily via email, social media, and a meeting website. To do that, we have lists of individuals that have responded previously on this topic, lists of partner organizations that will promote the event through their communications and social media. As this is not a research study, we do not have a detailed sampling plan.

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

[X] 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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