Form 1 Abstract Form

ATTACHMENT B - A Virtual Forum on National Institute on Alcohol Abuse and Alcoholism (NIAAA)-supported COVID-19 Research -- Abstract Form

Thank you for your interest in the Virtual Forum on NIAAA-Supported COVID-19 Research. Please fill out the abstract form below and return it by email to your NIAAA Project Officer.

Deadline is October 28, 2022

OMB No. 0925-0740

Expiration Date: 9/2025

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(Yes/No) ____ I am the Principal Investigator (PI) of an NIAAA-issued grant, administrative supplement, or competitive revision that addresses the relationship between alcohol and the COVID-19 pandemic and/or the SARS-CoV-2 virus.

(Y/N) ____ My research under this award has progressed to the point that there are results that can be shared with NIAAA staff and other NIAAA-funded investigators.

(Y/N) ____ I am interested in participating in a virtual research forum in late November or early December of 2022 to present my research in a brief “data blast” format.

(Y/N) ____ I have attached an abstract (200 words or less) describing the research I would like to present at the proposed virtual research forum.

(Y/N) ____ Do you have any special considerations we should take into account? Please specify.

Name:

Grant Title:

COVID grant/supplement number:

RFA / PA / NOSI:

Description of Research (200 words)

• Key research question(s):

• Methods:

• Results:

• Conclusions: