Profession (Insert Description) Total Number of Attendees Total Number of Attendees whose (Provide Best Estimate) Travel Expenses will be paid by NIH # of Federal Attendees From above, # Federal Travelers # of Non-Federal Attendees From above, # of Non-Federal Travelers Justification for the number of attendees Primary Method Used to Support the Conference (Check One) Government Staff Contractor/Planner Other (Describe Grant or Cooperative Support below) Agreement Cost Information Total Estimated Cost $ Cost Per Attendee: $ Details on Costs to be Funded by HHS (See Last Page for Explanation) Attendance Costs If multiple ICs are participating in your conference, Hosting Costs please include the total NIH costs below. You will be asked to break out costs by NIH IC as an attachment to this submission. Contractor/Planner $ Federal Attendee Travel $ Grant/Co-Ag $ Non Federal Attendee Travel $ Meeting Space/Venue $ Federal Attendee Exhibit Costs $ Registration Website $ Non Federal Attendee Exhibit $ Audio Visual $ Federal Attendee Registration $ Fees Speaker Fees $ Non Federal Attendee Reg. Fees $ Printing $ Federal Attendee Other Costs $ (Explain below) Promotional Materials $ Training Materials $ Non Federal Attendee Other $ $ Costs (Explain below) If charging Registration Fees to hold an NIH Explanation of Other Costs for Federal/Non Federal Conference, explain the nature of the fees, provide Attendees: the estimated amount of fees to be collected/used), and cite the authority used: Hosting Cost Explanation: Cite Authority for paying travel costs of Non-Federal Attendees, Explain, and Justify: Conference Sponsorship funded by another NIH ICs: $ Sponsor provides funding for expenses incurred by another NIH IC for planning and – conducting a conference. Reminder: Conferences that include food as part of the total estimated cost will not be approved.
Profession (Insert Description) Total Number of Attendees (Provide Best Estimate) Total Number of Attendees whose Travel Expenses will be paid by NIH # of Federal Attendees From above, # Federal Travelers # of Non-Federal Attendees From above, # of Non-Federal Travelers Justification for the number of attendees Primary Method Used to Support the Conference (Check One) Government Staff Contractor/Planner Support Other (Describe below) Grant or Cooperative Agreement Cost Information Total Estimated Cost $ Cost Per Attendee: $ Details on Costs to be Funded by HHS (See Last Page for Explanation) Hosting Costs Attendance Costs If multiple ICs are participating in your conference, please include the total NIH costs below. You will be asked to break out costs by NIH IC as an attachment to this submission. Contractor/Planner $ Federal Attendee Travel $ Grant/Co-Ag $ Non Federal Attendee Travel $ Meeting Space/Venue $ Federal Attendee Exhibit Costs $ Registration Website $ Non Federal Attendee Exhibit $ Audio Visual $ Federal Attendee Registration Fees $ Speaker Fees $ Non Federal Attendee Reg. Fees $ Printing $ Federal Attendee Other Costs (Explain below) $ Promotional Materials $ Training Materials $ Non Federal Attendee Other Costs (Explain below) $ $ If charging Registration Fees to hold an NIH Conference, explain the nature of the fees, provide the estimated amount of fees to be collected/used), and cite the authority used: Explanation of Other Costs for Federal/Non Federal Attendees: Hosting Cost Explanation: Cite Authority for paying travel costs of Non-Federal Attendees, Explain, and Justify: Conference Sponsorship funded by another NIH ICs: Sponsor – provides funding for expenses incurred by another NIH IC for planning and conducting a conference. $ Reminder: Conferences that include food as part of the total estimated cost will not be approved.
atta_nihcnfgrntrqstappvl_041415_508.docx