ATTACHMENT19-Invoice_PostConferenceWorksheet.pdf

: __________________ Phone No: ________________

_________________ Phone No: _________________ __________________ Phone No: ________________ ce: ______________________ nter (IC):

cer Officer:

son (if different than PO):

mber:

/Work Assignment Number (if applicable)

Title onferen of the number and type of attendees:

of Federal Attendees __________ of HHS Federal Attendees of Non-HHS Federal Attendees No. of Non-HHS Federal Attendees charged a registration fee________ Rationale for charging registration fee:

Rationale for charging registration fee:

Rationale for not charging registration fee:

No. of Attendees _________ (lines 10a + 10d)

iii. No. of Non-HHS Federal Attendees not charged a registration fee Rationale for not charging registration fee:

o. of Non-Federal Attendees

i. No. of Non-Federal Attendees to be charged a registration fee

ii. No. of Non-Federal Attendees not charged a registration fee otal otal No. of Fee-Paying Attendees ________ (lines 10.c.i + 10 d.i) otal Registration Fees Collected (Offset): $

FORM APPROVED: OMB No. 0990-0115

Post-Conference Expense Offset Worksheet

1. Institute/Ce

2. Project Offi

3. Contracting

4. Contact per

5. Contract Nu

6. Task Order

7. Contractor:

8. Conference

9. Date(s) of C

10. Description

a. No.

b. No.

c. No.

i.

ii.

d. N

e. T

f. T

g. T

Post-Conference Expense Offset Worksheet (3/2008) Page 1 of 2

Post-Conference Expense Offset Worksheet

Contract Number: _____________________

Task Order/Work Assignment Number: ______________

Conference Title

Conference Expense/Registration Information Actual Dollar Amt.

1. Direct Labor (specify by labor category)

2. Materials

3. Reproduction Costs

4. Conference Space/Meeting Rooms

5. Travel and/or Per Diem (deduct meals that are provided)

6. Hotel/Accommodations/Lodging rooms

7. Speaker Fees/Honoraria/Stipend

8. Audio Visual or other presentation costs

9. Transcription or Recording services

10. Light Refreshments

11. Meals

12. Other Direct Costs (list all other expenses and the associated costs for each)

13. Indirect Expenses (Fringe, Overhead, G&A)

14. Fee (if applicable)

15. Total Conference Costs (Sum of lines 1 - 14)

16. Per Person Registration Fee

17. No. of Fee Paying Attendees

18. Total Registration Fees Collected (line 16 x line 17) *Must be less than Total Conference Costs (line 15)

19. Conference Costs Minus Registration Fee (line 15 – line 18)

NIH estimates that it will take 180 minutes to complete this form. This includes time for reviewing the instructions, gathering needed information, and completing the form. 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. If you have comments regarding this burden estimate or any other aspects of the collection of information, including suggestions for reducing this burden, send comments to NIH Project Clearance Office, 6705 Rockledge Drive MSC 7974, Bethesda, MD 20892-7974, Attention: PRA (0990-0115). Do not return the completed form to this address.

Post-Conference Expense Offset Worksheet (3/2008) Page 2 of 2