Registration

Registrations 2023 (#6)

OMB No.: 0925-0740
Expiration Date: 09/30/2025

Public reporting burden for this collection of information is estimated to average 3 minutes per response. including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0740). Do not return the completed form to this address.

First Name

Last Name

Phone

Address

City

State

Zip Code

Country

Affiliation/Company/ Institution/Organization

Other Institutional Affiliation Primary Job Setting

Title/Position/Career Stage

Other Title/Position/Career Stage Primary Job Duties

Indicate which meeting sessions you would like to attend.

Session 5: September 21, 2023 (12:30 P.M. – 2:00 P.M. ET)

Engaging Community Stakeholders to Reduce Mental Health Inequities in the Hispanic Community

Session 6: October 25, 2023 (9:00 A.M. – 11:00 A.M. ET)

National Institute of Mental Health James Jackson Memorial Award Lecture

Request for Reasonable Accommodations

Yes (specify)

Specify Request for Reasonable Accommodations

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