GenIC Request

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-1050)

TITLE OF INFORMATION COLLECTION: 2018 Science Ambassador Fellowship Exit Satisfaction Survey

PURPOSE:

The Centers for Disease Control and Prevention (CDC) seeks to obtain Office of Management and Budget (OMB) approval to collect feedback for the 2017 CDC Science Ambassador Fellowship. The Science Ambassador Fellowship is held annually for the purpose of (1) providing a training experience for middle school and high school teachers to link teachers with CDC subject matter experts to develop effective public health-related lesson plans that meet National Science Education Standards, and (2) increasing the number of teachers who integrate public health and epidemiology concepts into their science education curricula and, additionally, share these resources with their communities. The goals of this survey are to improve Fellowship experiences and ensure the Fellowship is meeting its goals and participant needs. This information collection will be used by Science Ambassador Fellowship planners to refine the Fellowship and to improve logistics, communication, and quality of future sessions.

DESCRIPTION OF RESPONDENTS:

Respondents to the 2017 Science Ambassador Fellowship Exit Satisfaction Survey (Attachment 1, Survey Word document and Attachment 2, Survey Screenshots) will be the 2017 Science Ambassador Fellows. Science Ambassador Fellows include middle school and high school teachers from school districts across the United States. No personally identifiable information (PII) will be collected; should any respondents provide PII, it will not be retained.

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: Kelly L Cordeira, MPH

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 [x] 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

The feedback survey will be web-based and include (at most) 15 questions. Respondents will take approximately 10 minutes to complete the survey through Survey Monkey. This estimate is based on piloting the survey with five CDC Staff. For the 2017 Science Ambassador Fellowship, we are seeking approval to collect feedback from 30 non-federal individuals (i.e., middle school, high school, and community college teachers). Given 30 respondents with a response time of 10 minutes each, the total response burden will be 5 hours. There will be no direct costs to the respondents other than their time to respond to the survey.

Category of Respondent	No. of Respondents	Participation Time	Burden
Individuals	30	10/60	5 hours
Totals			5 hours

FEDERAL COST:

The average annualized cost to the Federal Government to collect this information is $272.22. This estimate is based on the time required for one senior CDC scientist (GS-13) to supervise and for one Student Worksite Experience Program (SWEP) volunteer to design the survey, develop the web-based survey, implement the survey, analyze the data, and develop recommendations for improving the annual Science Ambassador Fellowship based on the results.

Staff or Contractor	Hours	Average Hourly Rate	Cost
Volunteer survey design, create web-based survey, implementation, analysis, and reporting (GS-8 equivalent)	40	$0	$0.00
FTE Supervisor (GS-13)	6	$45.37	$272.22
Totals			$272.22

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? [ ] Yes [x] No

The 2017 fellows will be invited to participate in the Science Ambassador Fellowship Exit Satisfaction Survey. After the Science Ambassador Fellowship has concluded, an invitation email (Attachment 3, Invitation Email) with a link to the survey will be sent to all 2017 Science Ambassador Fellows who provided an email address. Respondents will be given 2 weeks to respond to the survey. Respondents will have to complete the survey in one sitting as the survey tool does not allow respondents to return to edit or complete the survey. The survey does not track individual responses. A reminder email (Attachment 4, Reminder Email) will be sent twice: one email at the beginning of week 2 and the second email on the day the survey closes.

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

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