NIAID_generic_clearance_Fast Track Application-BTCG 2013

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0925-0668)

T ITLE OF INFORMATION COLLECTION:

Evaluation Form for the Bridging the Career Gap for Underrepresented Minority Scientists workshop

PURPOSE:

The purpose of the workshop is to allow for the exchange of science; to impart information on applying for research project grants; to acquaint attendees with the opportunities and options open to them in the field of biomedical research; and to provide an opportunity to meet with NIAID intramural and extramural staff members for the purpose of establishing mentors. It also highlights the Institute’s recognition that these young researchers are seen as future NIH/NIAID grantees. By establishing a "bridging" program, the careers of these young investigators could be nurtured, and the Institute would receive feedback on the effectiveness of these programs in attracting minority scientists to the NIAID research agenda.

NIAID is interested in participants’ overall satisfaction with the Bridging the Career Gap for Underrepresented Minority Scientists Workshop. Customer satisfaction data will be gathered to inform improvements to the 2015 workshop.

DESCRIPTION OF RESPONDENTS:

Potential survey respondents are Pre/Post-Doctorate minority scientists who attended the Bridging the Career Gap for Underrepresented Minority Scientists Workshop. A maximum of 100 participants are expected to complete the workshop survey.

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:___Raushanah Newman_____________________________________________

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

Category of Respondent	No. of Respondents	Participation Time	Burden
Private sector (workshop participants)	50-100*	5 minutes	8 hours
Totals

*Registration for this workshop is still open. The projected attendance is 50-100.

FEDERAL COST: The estimated annual cost to the Federal government is $0 ___________

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 survey will be printed on paper and given to the participants to complete at the conclusion of the workshop. The participants will be asked to return their completed surveys at the registration desk prior to leaving the workshop venue.

Administration of the Instrument

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

[ ] Web-based or other forms of Social Media

[ ] Telephone

[X] 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.

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