Form 1 HHS SBIR Showcase Event Feedback Form

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

HHS_SBIR_Showcase_Event_Feedback_Form_2016-07-05

HHS SBIR/STTR Showcase Conference Feedback

OMB: 0925-0648

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HHS SBIR/STTR Showcase Event Feedback Form, OMB No. 0925-0648 Exp. Date
3/31/2018
1. Welcome

Thank you for representing HHS-funded companies! Please take a few minutes to provide
feedback on your experience. Your input helps us provide resources that work for you and
allow us to continue to provide this type of support for awardees. We take the sensitivity
and confidentiality of your information seriously. This information is for internal use only.
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive,
MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0648). Do not return the completed form to this address.

OMB No. 0925-0648
Exp. Date 3/31/2018

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HHS SBIR/STTR Showcase Event Feedback Form, OMB No. 0925-0648 Exp. Date
3/31/2018
2.

* 1. Please select the event you attended from the following drop down menu.

Other (please specify)

2. Contact Information
Please note if your company uses alternative names, or has changed names, from the company name
used for the SBIR/STTR award.
Company
First Name
Last Name
Title/Role
State

-- select state --

Email Address

3. Did this event provide a unique opportunity that would not otherwise have been possible?
Yes
No
Please describe.

* 4. Would you have attended this event without HHS/NIH support?
Yes
No
N/A

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* 5. What were your primary goals for attending this event?
Select your top 2 goals.
Seeking strategic partners (large business)
Seeking investment
Seeking scientific collaborators
Customer discovery
Increasing company visibility and exposure
Gaining insight into the competitive landscape
Gaining insight into the intellectual property landscape
Validating clinical indications
Validating your business model
Other (please specify)

* 6. Did this event help you achieve your primary goals?
Yes
No
Please explain.

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7. How useful was this event for
Not at all

Somewhat

Moderately

Mostly

Extremely

N/A

Connecting with potential
strategic partners?
Connecting with potential
investors?
Connecting with potential
scientific collaborators?
Connecting to potential
customers?
Company visibility and
exposure?
Gaining insight into the
competitive landscape?
Scientific or medical
education?
Learning more about
running your business?

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HHS SBIR/STTR Showcase Event Feedback Form, OMB No. 0925-0648 Exp. Date
3/31/2018
3.

8. Select the types of organizations and/or people you met with.
Venture Capital Investors
Angel Investor
Potential strategic partner (medical technology/ pharmaceutical/ biotechnology company)
Potential scientific collaborator
Potential customer
NIH staff
Other (please specify)

9. Were there sufficient numbers of investors or potential partners interested in your technology area in
attendance?
Yes
No
Please explain.

10. How many investors or strategic partners did you meet with at this event?
With high level of interest in my
technology

With moderate level of interest in
my technology

With minimal/no interest in my
technology

Formal Meetings
Informal Meetings

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11. Were the meetings productive?
Yes
No
Please explain, including any differences between the formal and informal meetings.

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HHS SBIR/STTR Showcase Event Feedback Form, OMB No. 0925-0648 Exp. Date
3/31/2018
4.

12. If you gave an oral or poster presentation at this event, was it a worthwhile experience?
Yes - both types of presentation were worthwhile.
Yes - the oral presentation was worthwhile.
Yes - the poster presentation was worthwhile.
No.
N/A
Please explain.

13. If you received HHS/NIH mentoring in preparation for this event (e.g. pitch coaching), how useful was
it?
Not at all

Somewhat

Moderately

Mostly

Extremely

N/A

14. Would you recommend that other companies similar to yours (same stage and/or technology type)
attend this event?
Yes
Yes, but only if they can present their work.
No
Please explain.

15. How could NIH have improved this event or exhibitor/presenter experience for you?
For example, is there information about the event that could have been provided in advance and would have made the event more
productive?

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16. Is there anything else you'd like to share with us?
For example, are there other events that would be valuable opportunities? Has your company received any media attention as a result
of participating in this event?

17. We are trying to better understand the role of women in our small business community. Help us by
selecting whether any of the following are true of your company.
My company is majority-owned by a woman or women.
My company is partially (50% or less) owned by a woman or women.
My company was co-founded by a woman or women.
A woman (or women) holds a C-level leadership role(s) in my company.
None of the above are true about my company.
Other important information about women in my company.

18. We are trying to better understand the role of underrepresented racial and ethnic groups in our small
business community. Help us by selecting whether any of the following are true of your company.
The following racial and ethnic groups have been shown to be underrepresented in biomedical research: African Americans, Hispanic
Americans, Native Americans, Alaskan Natives, Hawaiian Natives, and natives of the U.S. Pacific Islands.
My company is majority-owned by a member(s) of an underrepresented racial/ethnic group.
My company is partially (50% or less) owned by a member(s) of an underrepresented racial/ethnic group.
My company was co-founded by a member(s) of an underrepresented racial/ethnic group.
A member(s) of an underrepresented racial/ethnic group holds a C-level leadership role(s) in my company.
None of the above are true about my company.
Other important information about members of underrepresented racial/ethnic groups in my company.

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