Request for Clearance

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-0919)

TITLE OF INFORMATION COLLECTION:

2014 Epidemic Intelligence Service (EIS) Conference Customer Satisfaction Survey

PURPOSE:

The Centers for Disease Control and Prevention (CDC) seeks to obtain Office of Management and Budget (OMB) approval to conduct a customer feedback survey of the 2014 Epidemic Intelligence Service (EIS) Conference hosted from April 28 – May 1, 2014. The EIS Conference is held on an annual basis with the purpose of providing a forum for EIS officers to give scientific presentations (oral or poster), increase their knowledge of recent investigations and the significance to public health, and maintain and increase their skills in determining the appropriateness of epidemiologic methods, presenting and interpreting results clearly, and developing appropriate conclusions and recommendations. The overall EIS Conference goals are to 1) Provide a forum for EIS officers, alumni, and other public health professionals to engage in the scientific exchange of current epidemiologic topics, 2) Highlight the breadth of epidemiologic investigations at CDC, and 3) Provide a venue for the recruitment of EIS graduates into leadership positions at CDC and state and local health departments. CDC is requesting OMB approval to conduct a customer service feedback survey to provide information that will be useful for ensuring that the EIS Conference is meeting its goals and the needs of its attendees.

DESCRIPTION OF RESPONDENTS:

Respondents to the Customer Satisfaction Survey of the 2014 EIS Conference are conference registrants and will be considered individuals. Conference registrants come from a variety of fields, some of which include local, state, and federal government employees; EIS Officers; researchers; health care providers; health educators; and policy makers.

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: ____Diana Bensyl____________________________________________

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

3. If Applicable, has a System or Records Notice 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

This will be a web-based survey that includes 32 questions. Respondents to the survey will be registrants of the 2014 EIS Conference. The survey will be completed over the web and will take approximately 5 minutes to complete. This estimate is based on an analysis of time to complete from a pilot survey of 5 CDC staff. We expect an 80% response rate from the EIS Conference’s approximately 1,800 registrants. Based on this, we will collect feedback from approximately 1,440 EIS Conference registrants (e.g., local, state, and federal government employees; EIS Officers; researchers; health care providers; health educators; and policy makers). Given 1,800 respondents with a response time of 5 minutes each, the total response burden will be 150 hours. There will be no direct costs to the respondents other than their time to participate in the survey.

Category of Respondent	No. of Respondents	Participation Time	Burden Hours
Individuals	1,800	5/60	150
Totals			150

FEDERAL COST: The estimated annual cost to the Federal government is $1,690.

The average annualized cost to the Federal Government to collect this information is $1,690. This estimate is based on the time required for 1 senior-level (GS-14) and 1 CDC Contractor (GS-11) to design the survey, develop the web-based survey, implement the survey, analyze the data, and develop recommendations for improving the EIS Conference based on the results.

Staff or Contractor	Hours	Average Hourly Rate	Cost
Contractor survey design, create web-based survey, implementation, analysis, and reporting (GS-11 equivalent)	40	$31.00	$1,240
FTE survey design, implementation, analysis, and reporting (GS-14)	10	$45.00	$450
Totals			$1,690

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)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

The Customer Satisfaction Survey of the 2014 EIS Conference will be administered as a web-based survey via Survey Monkey. All registrants for the 2014 EIS Conference who provide an email address will be sent a link to complete the survey at the conclusion of the conference. Responses will be used to evaluate to what extent the EIS conference met its stated goals, identify aspects of the conference that could be improved next year, and gather data to assist in making future decisions about conference logistics.

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.

Instructions for completing Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”

TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the subject of the request. (e.g. Comment card for soliciting feedback on xxxx)

PURPOSE: Provide a brief description of the purpose of this collection and how it will be used. If this is part of a larger study or effort, please include this in your explanation.

DESCRIPTION OF RESPONDENTS: Provide a brief description of the targeted group or groups for this collection of information. These groups must have experience with the program.

TYPE OF COLLECTION: Check one box. If you are requesting approval of other instruments under the generic, you must complete a form for each instrument.

CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.

Personally Identifiable Information: Provide answers to the questions.

Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.

BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households;(2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be selected.

No. of Respondents: Provide an estimate of the Number of respondents.

Participation Time: Provide an estimate of the amount of time required for a respondent to participate (e.g. fill out a survey or participate in a focus group)

Burden: Provide the Annual burden hours: Multiply the Number of responses and the participation time and divide by 60.

FEDERAL COST: Provide an estimate of the annual cost to the Federal government.

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. Please provide a description of how you plan to identify your potential group of respondents and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.

Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.

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

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