Request for GenIC Approval

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-0974)

TITLE OF INFORMATION COLLECTION: 2015 Science Ambassador Workshop Satisfaction Survey

PURPOSE:

The Centers for Disease Control and Prevention (CDC) seeks to obtain Office of Management and Budget (OMB) approval to collect feedback for the 2015 CDC Science Ambassador Workshop held July 20-24, 2015 in Atlanta, GA. The Science Ambassador Workshop is held on an annual basis with the purposes to (1) provide a training experience for middle school and high school teachers to link teachers with CDC subject matter experts to develop effective public health-related lesson plans that meet National Science Education Standards, and (2) to increase the number of teachers who integrate public health and epidemiology concepts into their science education curricula and, additionally, share these resources with their communities. The goals of this survey are to improve workshop participants’ experiences and ensure the workshop is meeting its goals and participants’ needs. This information collection will be used by Science Ambassador Workshop planners to guide refinement of the workshop, improve logistics, communication, and quality of future workshop sessions.

DESCRIPTION OF RESPONDENTS:

Respondents to the 2015 Science Ambassador Workshop Satisfaction Survey (Attachment 1, Survey Word document and Attachment 2, Survey Screenshots) will be the participants of the 2015 Science Ambassador Workshop. Science Ambassador Workshop participants include middle school and high school teachers from a variety of school districts across the United States. No personally identifiable information (PII) will be collected; however, should any respondents provide PII, it will not be retained.

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: Ralph Cordell, PhD

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 [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

The feedback survey will be web-based and include 40 questions. Respondents will take approximately 20 minutes to complete the survey through SurveyMonkey®. This estimate is based on piloting the survey with five CDC staff. For the 2015 Science Ambassador Workshop, we are seeking approval to collect feedback from 36 non-federal individuals (i.e., middle school, high school, and community college teachers). Given 36 respondents with a response time of 20 minutes each, the total response burden will be 12 hours. There will be no direct costs to the respondents other than their time to respond to the survey.

Category of Respondent	No. of Respondents	Participation Time	Burden
Individuals	36	20/60	12 hours
Totals			12 hours

FEDERAL COST:

The average annualized cost to the Federal Government to collect this information is $1354.40. This estimate is based on the time required for one senior CDC scientist (GS-13/14) to supervise and for one CDC contractor (GS-9 equivalent) to design the survey, develop the web-based survey, implement the survey, analyze the data, and develop recommendations for improving the annual Science Ambassador Workshop based on the results.

Staff or Contractor	Hours	Average Hourly Rate	Cost
Contractor survey design, create web-based survey, implementation, analysis, and reporting (GS-9 equivalent)	40	$24.23	$969.20
FTE Supervisor (GS-14)	6	$64.20	$385.20
Totals			$1354.40

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? [ ] Yes [x] No

The 2015 attendees will be invited to participate in the Science Ambassador Workshop Satisfaction Survey. After the Science Ambassador Workshop has concluded, an invitation email (Attachment 3, Invitation Email) with a link to the survey will be sent to all 2015 Science Ambassador Workshop participants who provided an email address. Respondents will be given 2 weeks to respond to the survey. Respondents will have to complete the survey in one sitting as the survey tool does not allow respondents to return to edit or complete the survey. The survey does not track individual responses. A reminder email (Attachment 4, Reminder Email) will be sent twice: one email at the beginning of week 2 and the second email on the day the survey closes.

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

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