Request for Approval

Request for Approval under the “Generic Clearance for the Collection of
Routine Customer Feedback” (OMB Control Number: 3145-0215)
TITLE OF INFORMATION COLLECTION: EPSCoR Project Directors/Project
Administrators Meeting Feedback
PURPOSE: The National Science Foundation’s (NSF) EPSCoR would like to obtain
feedback on the recent Project Directors/Project Administrators meeting so that we can better
respond to the changing needs of the community in future meetings. The meeting was held May
21-22, 2012 at NSF.
DESCRIPTION OF RESPONDENTS: Respondents lead and or manage statewide research
and education projects funded by NSF.
TYPE OF COLLECTION: (Check one)
[ ] Customer Comment Card/Complaint Form
[ ] Usability Testing (e.g., Website or Software
[] Focus Group

[ x] Customer Satisfaction Survey
[ ] Small Discussion 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:_Suzanne H. Plimpton, NSF Reports Clearance Officer__________________________
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
Participation
Respondents Time
75
5-10 min

Totals

75

1

5-10 min

Burden
12.5 hrs
12.5

hrs

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 targeted respondents are individuals who attended the meeting (see attached list)

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.
2

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. 85
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) 5-10 minutes
Burden: Provide the Annual burden hours: Multiply the Number of responses and the
participation time and divide by 60. 14.2 hours
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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EPSCoR Project Directors/Project Administrators Meeting
May 21st-22nd 2012
Name
Felicia Jenkins
Mahesh Hosur
Mark Myers
Kim Boykin
Peter Schweitzer
Pips (Alice) Veazey
Cathy Ma
Gail McClure
Marta Collier
Amy Broadhurst
Donald Sparks
Karl Steiner
Jim Gaines
Hanalei Abbott
Zeada Pachecano
Kevin Kelly
Nancy Glenn
Peter Godwin
Rick Schumaker
Heather Conley
Jordan Cohen
Robert Brown
Doug Byers

May 21st
y
y
y
N
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y

Kristin Bowman
Barbara Kucera
Jeff Mossey
Rodney Andrews
Jim Gershey

y
y
y
n
y

attended
May 22nd
y
y
y
Y
y
y
y
y
y
y
y
n
n
y
y
y
y
y
y
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n
y

Michael Khonsari
Jennifer Dunham
Michael Eckardt
Vicki Nemth
Katie Echols
Sandra Harpole
Teresa Gammill
Anna Waldron
Marilyn Soucie
Joe Polacco
Mark Young
Martha Peters
Sylvia Moore
Fred Choobineh
Gayle Dana
Marcie Jackson
Michele Casella
Jan Nisbet
Michelle Gregoire
Anna Morrato
Mary Jo Daniel
William Michener
Cathy Lerud
Mark R. Hoffmann
Sheri Anderson
Elizabeth Jung
Alicia Knoedler
James Wicksted
Gina Miller
Brad Weiner
Manuel Gomez

y
n
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y

y
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y
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y
y
y
n
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y
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Maria Vargas
Jennifer Specker
Philip Veillette
Sara MacSorley
Scott Little
Prakash Nagarkatti
James Rice
Karen Theodosopoulos
John Hopkins
Joshua Francois
Samantha Brown
Todd Crowl
Judy Van Houten
Kelvin Chu
Lillian Gamache
Camille McKayle
Kaisa Prentice
Nick Drayton
Annette Echols
Jan Taylor
Anne Sylvester
William Gern
Rick Matlock

n
n
y
y
y
n
y
n
y
y
y
y
y
y
y
y
y
y
y
y
y
n
y

n
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n
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y
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y
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