Fast-Track Template

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0925-0643 Exp. Date: 10/31/2017)

TITLE OF INFORMATION COLLECTION: BIRCWH Principal Investigator, Mentor, and Scholar Satisfaction Surveys

PURPOSE:

Online customer satisfaction surveys will be used to obtain feedback on the components of the Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) program. The populations are principal investigators, mentors, and scholars.

Feedback collected from the surveys will be used by the Office of Research on Women’s Health (ORWH) to assess whether or not the needs of the principal investigators, mentors, and scholars are being met. Results will inform program planning.

The Principal Investigator Satisfaction survey will be sent to current and former principal investigators of the BIRCWH program. The survey will include questions about participants’ level of satisfaction with different aspects of the program, such as: interaction with mentors, interaction with scholars, institutional support, interactions with the NIH, and the overall management of the BIRCWH program.

The Mentor Satisfaction survey will be sent to current and former mentors of the BIRCWH program. The survey will include questions on participants’ level of satisfaction with different aspects of the program, such as: institutional support, quality of scholar interaction, training and career development opportunities for BIRCWH scholars, and the overall BIRCWH program in preparing scholars to become independent, interdisciplinary researchers in women’s health.

The Scholar Satisfaction survey will be sent to current and former scholars of the BIRCWH program. The survey will include questions about participants’ level of satisfaction with different aspects of the program, such as: institutional support, mentoring support, and career development opportunities in addition to mentoring.

DESCRIPTION OF RESPONDENTS:

The respondents will be current and former BIRCWH principal investigators, mentors, and scholars of the NIH BIRCWH program.

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: Jennifer Guimond, Ph.D.

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

Personally Identifiable Information:

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

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

3. If Applicable, has a System of Records Notice been published? [X] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X] No

ESTIMATED BURDEN HOURS and COSTS

Category of Respondent	No. of Respondents	No. of Responses per Respondent	Time per Response (in hours)	Total Burden Hours
Private sector not-for- profit: BIRCWH Principal Investigators (former and current)	90	1	20/60	30
Private sector not-for- profit: BIRCWH Mentors (former and current)	2,200	1	20/60	733
Private sector not-for- profit: BIRCWH Scholars (former and current)	680	1	20/60	227
Totals	2,970	1	20/60	990

Category of Respondent	Total Burden Hours	Wage Rate*	Total Burden Cost
Private sector not-for- profit: BIRCWH Principal Investigators (former and current)	30	$96.66	$2,899.80
Private sector not-for- profit: BIRCWH Mentors (former and current)	733	$81.02	$59,387.66
Private sector not-for- profit: BIRCWH Scholars (former and current)	227	$61.51	$13,962.77
Totals	990		$76,250.23

*http://www.aaup.org/sites/default/files/files/2015salarysurvey/appendix1.pdf (Average annual salaries for professors from 22 different schools/1,560 hours per 9-month academic year. Principal Investigators: Average of full professor salaries. Mentors: Average of full and associate professor annual salaries. Scholars: Average of associate and assistant professor annual salaries.)

FEDERAL COST: The estimated annual cost to the Federal government is: $76,938.30

Staff	Grade/Step	Salary*	Number of Hours	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Personnel from the NIH Office of Research on Women’s Health	GS-14	$114,480	10.4		$572.40
Personnel from the NIH National Institute of Child Health and Human Development	GS-14	$114,480	10.4		$572.40
Personnel from the NIH Office of Research on Women’s Health	GS-15	$158,700	10.4		$793.50
Total Cost for Government Personnel					$1,938.30
Estimated Cost for Survey Development/Contractor
Item			Number of Surveys	Cost per Survey	Annualized Cost ($)
Principal Investigator Satisfaction Survey			1	$25,000	$25,000
Mentor Satisfaction Survey			1	$25,000	$25,000
Scholar Satisfaction Survey			1	$25,000	$25,000
Total Cost for Survey Development/Contractor					$75,000

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 list of BIRCWH principal investigators, mentors, and scholars was obtained from the NIH Query, View and Report (QVR) system. The survey will be sent to everyone so no sampling plan is needed.

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.

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