OMB No.: 0925-XXXX
Expiration Date: xx/xx/20xx
Collection of this information is authorized by The Public Health Service Act, Section 410 (42 USC 285). Rights of participants are protected by The Privacy Act of 1974. Participation is voluntary, and there are no penalties for not participating or withdrawing from the study at any time. The information collected in this study will be kept private to the extent provided by law. Names and other identifiers will not appear in any report of the study. Information provided will be combined for all participants and reported as summaries. You are being contacted by telephone to complete this interview as part of a full-scale evaluation of the IMAT Program.
Public reporting burden for this collection of information is estimated to average 30 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-XXXX). Do not return the completed form to this address.
Hello, is this Dr. _______? My name is __________________, and I’m a member of the independent evaluation team for NCI’s full-scale Innovative Molecular Analysis Technologies program evaluation. I work for Ripple Effect, a research and evaluation firm in Rockville, MD, charged with the task of conducting this evaluation. We greatly appreciate your willingness to answer a few questions about the technology to emerge from the IMAT Program and would like for you to be totally candid.
As you may or may not know, the IMAT program provides early stage support for innovative technologies that contribute to the advancement of cancer relevant research. You have been identified as someone familiar with a relevant field of research for which one or several of these technologies may have offered significant contributions to advancing such research. In particular, the _______ is one of these innovative technologies supported by IMAT program grants. I want to assure you that your participation is voluntary. We expect our discussion to take about 30 minutes.
If yes: Good. We realize that your time is valuable, so let’s get started.
If no: Would you like to schedule another time for this discussion? (Try to schedule another time and thank the respondent for his or her willingness to participate.)
What is your role related to this technology?
Click here to enter text.
How did you find out about the technology?
Click here to enter text.
How are you using the technology in your research/practice?
Click here to enter text.
To what extent is the technology critical in your research/practice?
Click here to enter text.
How has this technology impacted public health?
Click here to enter text.
How has this technology impacted this field of research?
Click here to enter text.
I want to thank you for the time and input into this study today. May we have your permission to attribute your responses today to your name and role in reports and other evaluation-related materials?**
☐Yes
☐No
If yes, thank you.
If no, thank you. Your responses will be kept secure, to the extent provided by law.
If you have any questions, feel free to contact Tony Dickherber with any additional questions at 301-480-2889 or by email at [email protected].
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Tony Dickherber |
File Modified | 0000-00-00 |
File Created | 2021-01-25 |