CGH Kenya Fast Track Template

Request for Approval under the

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

(OMB Control Number: 0925-0642-39, Expiration Date 9/30/2014)

TITLE OF INFORMATION COLLECTION:

Satisfaction with Kenya Cancer Control and Cancer Research Stakeholder Meeting

PURPOSE:

The National Cancer Institute’s (NCI) Center for Global Health (CGH) is organizing an interactive meeting called Kenya Cancer Control and Cancer Research Stakeholder Meeting. CGH aims to increase the capacity for cancer control efforts in order to decrease the burden of cancer in Kenya. This workshop aims to identify and leverage the research capacity, relationships, and infrastructure created by existing programs (those run by the US government, by NCI-designated cancer centers, and others) to foster new collaborations and relationships in the region. This workshop will work specifically to streamline and coordinate in-country efforts related to cancer control planning and implementation science research. NCI and its US government partners have the potential to benefit NGOs and other in-country partners who are looking to expand their cancer research and control presence in-country.

The purpose of this data collection is to gather participants’ feedback on the meeting. We will use a short web-based survey to assess whether the meetings objectives were met. The feedback provided by participants will help CGH determine whether we will organize other similar meetings in other countries, and if so, what improvements can be made to better further our objectives.

DESCRIPTION OF RESPONDENTS:

The respondents to this survey will consist of Kenya Cancer Control and Cancer Research Stakeholder Meeting participants. Based on the range of meeting attendees, we anticipate that our participants will come from a variety of different organizations, including representatives of the Kenyan Ministry of Health, NCI-designated cancer centers, universities, non-profits and US government agencies working on global health activities.

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: Kalina Duncan

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

Personally Identifiable Information:

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

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

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] 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	Burden
Individuals	70	20/60	23

Total Burden Hours used for IC’s to date: 2057

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

Total Burden Hours currently requested: 23

FEDERAL COST: The estimated annual cost to the Federal government is $500.00.

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

The sample of respondents will be derived from the registration list of participants for the Kenya Cancer Control and Cancer Research Stakeholder Meeting. Based on the registration list, individuals identified will be invited by email (Attachment 1) to complete a web-based survey (Attachment 2) estimated to take approximately 20 minutes.

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

Please make sure that all instruments, instructions, and scripts are submitted with the request.

Attachment 1: Invitation

Attachment 2: Screenshots

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