Form 6000-019 NAMs Pre-Training Registration

OMB Control No: 2030-0051

Expiration Date: 05/31/2024

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. OMB Control Number: 2030-0051 Responses to this collection of information are voluntary. 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. The public reporting and recordkeeping burden for this collection of information is estimated to range from 1-3 minutes per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

Items in brackets [item] indicate that the standardized text, e.g., [EPA NAMs tool], will be replaced with the actual NAMs web tool name, e.g., ECOTOX Knowledgebase, or options specific to that web tool

A red asterisk * indicates questions that are required for training registration via the Zoom platform

NAMs Pre-Training Registration

This training supports the EPA’s New Approach Methods (NAMs) initiative. NAMs include any technologies, methodologies, approaches, or combinations thereof that can be used to provide information on chemical hazard and potential human exposure that can avoid or significantly reduce the use of testing on animals. NAMs enable risk assessors to more rapidly address public health challenges and chemical regulation. Thank you for your interest in this training opportunity on [EPA NAMs tool]!

Indicated below, you must fill in your contact information to register for this training. All other responses are voluntary. Read the burden statement for this survey collection: https://www.epa.gov/chemical-research/nams-training-survey-burden-statement.

1. Please fill in the following fields:

   • First Name*

   • Last Name*

   • Email Address*

   • Organization*

   • Role/Title

   • City

   • State/Province

   • Country/Region

2. How often do you currently use [EPA NAMs tool]?

   • Never

   • Occasionally

   • Frequently

3. How would you rate your overall level of understanding of [EPA NAMs tool]?
   (5=expert, 4=above average, 3=average, 2=little, 1=novice, 0=not applicable)

4. Please describe your current level of confidence in using [EPA NAMs tool].

(4= Very confident, 3= Confident, 2= Somewhat confident, 1= Not at all confident, 0=not applicable)

5. Please select the option that best fits you. “I prefer that the training on [EPA NAMs tool] be presented at a(n) ______ level:

   • Basic/Introductory

   • Intermediate

   • Advanced

6. Please indicate whether you have a preferred [breakout room or interactive activity] topic. We will do our best to accommodate preferences based on availability.

• No preference

• [Option 1]

• [Option 2]

• [Option 3]

• [Option 4]

7. Please select your preferred format for this [workshop/breakout session/interactive activity]. We will do our best to accommodate these preferences. Check all that apply.

• Step-by-step demonstration with instruction.

• Self-guided with moderators.

• Open forum discussion.

• Hybrid: largely self-guided, with moderator or other attendees demonstrating select questions

• Small group or 1:1 discussions.

• [Additional Option]

• [Additional Option]

• Other (please explain)

8. What do you most hope to learn at this training?

(please specify)

9. Please select the option that most closely fits your affiliation.

• US Federal Government or Federal Agency

• US Local / State / Tribal Government

• International Government or National Agency

• Industry / Corporate

• Consulting

• University or Academia

• Non-profit or Community Organization

• Concerned citizen

• Other: (please specify)

10. How did you hear about this training?

• EPA website

• EPA email

• EPA newsletter or listserv

• Social media

• Web search

• Conference

• Colleague

• Other

Following completion of the form, respondents will see the following message:

Thank you for registering for [EPA NAMs tool] training! Additional details and virtual event invite will be sent to the registered email.

EPA Form: 6000-019