#9 & #10_Fast-Track_Request_Fed_HD Calc

Request for Approval under the

“Generic Clearance for the Collection of Routine Customer Feedback” (NCI)

(OMB Control Number: 0925-0642-9 & 10, Expiration Date 9/30/2014)

T ITLE OF INFORMATION COLLECTION: HD*Calc Customer Satisfaction Survey for Different Category of Respondents: State (Sub-Study #9) and Federal Respondents (Sub-Study #10)

This sub-study is exactly the same as the previous sub-study that were approved (0925-0642-08), except the “Category of Respondent” and the “Number of Respondents” has been changed.

PURPOSE: The Health Disparities Calculator (HD*Calc) is statistical software designed to generate multiple summary measures to evaluate and monitor health disparities. HD*Calc

can be used either as an extension of SEER*Stat, allowing users to import Surveillance, Epidemiology, and End Results (SEER) data, or with other population-based health data. HD*Calc is available at http://seer.cancer.gov/hdcalc/. HD*Calc is supported by the Surveillance Research Program and Applied Research Program within the Division of Cancer Control and Population Sciences. This survey seeks to learn whether respondents are using HD*Calc, how they are using it, and whether they are finding it helpful. The survey solicits respondents’ suggestions regarding how NCI can improve HD*Calc or provide technical assistance that will facilitate more effective use of HD*Calc.

DESCRIPTION OF RESPONDENTS: Three different generic sub-study requests/templates will be submitted to request approval for HD*Calc users which will include private nonprofit organizations and academic institutions, public academic institutions, and Federal and State government agencies.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [X] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [ ] Other: ______________________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: ___Nancy Breen_____________________________________________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ X ] Yes [ ] No

2. If Yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [X] Yes [ ] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [X] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Total Burden Hours
State Government (Sub-study #9)	1	10/60	.16
Federal Government (Sub-study #10)	6	10/60	1
Totals	7		1

The other Category of Respondents (Private Sector Respondents n=19) was previously approved under 0925-0642-08.

Total Burden Hours used for IC’s to date: 469

Total Burden Hours Approved for IC’s under 0925-0642: 8750

Total Burden Hours currently requested: 1

FEDERAL COST: The estimated annual cost to the Federal government is $1,465 to survey all three Categories of Respondents.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [X] Yes [ ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)?

A Google search was conducted for HD*Calc, which yielded 123 results. Results comprised private nonprofit organizations and academic institutions, public academic institutions, and Federal and State government agencies. The results were reviewed to identify those organizations that seemed likely to conduct research, with the goal of identifying organizations that have research staff who use HD*Calc for research purposes at the organization. Respondents were limited to websites/social media platforms with a posted email address and a probable research focus. This review process identified 26 respondents. For this survey, the person or representative of the organization who is best equipped to respond to the survey is asked to do so. Therefore, the email invitation will encourage the original recipient to forward the survey link to another, more knowledgeable individual within the organization, if appropriate.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[X] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [ X ] No

List of instruments, instructions, and scripts submitted with this request is the same for both sub-studies #9 and #10:

Attachment # 1: Selected Screen Shots from Survey/Questionnaire

Attachment #2: Complete Set of Questions from Survey/Questionnaire

Attachment # 3: Email/Letter Invitation

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