DS Rodent Survey Fast Track Application

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

TITLE OF INFORMATION COLLECTION:
Survey of researchers studying rodent models for Down syndrome

PURPOSE:

The purpose of this survey is to learn how scientists use rodent models for DS research; assess satisfaction with currently available models; describe researchers' perceptions of the limitations of currently available models; and provide information to help assess future needs for such research resources.

DESCRIPTION OF RESPONDENTS:

Investigators who study Down syndrome using mouse models of the condition.

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:_Melissa A. Parisi, MD, 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 N/A

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ ] No. N/A

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
Individuals	100	1	10/60	17
Totals	100	100		17

Category of Respondent	Total Burden Hours	Wage Rate*	Total Burden Cost
Individuals	17	45.36	771
Totals	17	45.36	771

Source: https://www.bls.gov/oes/current/oes191021.htm

This is the average hourly salary of a biochemist or biophysicist.

FEDERAL COST: The estimated annual cost to the Federal government is $156_________

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight	15/10	161,900	0.1%		156
Contractor Cost					0
Travel					0
Other Cost					0
Total					156

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

We intend to identify our potential group of respondents by asking the organizers of the Trisomy 21 Research Society to send the link via email to the participants in the recent T21RS biennial conference (held June 7-11, 2017) in addition to its non-redundant membership roster. This is the key professional society for researchers who study Down syndrome, many of whom use murine models of the condition. Respondents will self-select based on whether they study rodent models of Down syndrome.

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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