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: Feedback for 2018 Place & Health conference

PURPOSE:
The CDC/ATSDR Geospatial Research, Analysis & Services Program (GRASP) provides
leadership and expertise in the application of the concepts, methods, and tools of geography and
geospatial information science to public health research and practice. GRASP provides GIS
mapping, analysis, and technology services and support to stakeholders both within and outside
of CDC. The Geography and Geospatial Science Working Group (GeoSWG) also works to share
best practices and knowledge in these fields. GRASP and GeoSWG work together to share
knowledge related to geospatial science in the field of public health.
The 2018 Place & Health Conference (formerly GIS Day) is an annual event that will be hosted
by GeoSWG in November 2017. The Place & Health Conference provides researchers from
CDC, local governments, and Atlanta area universities a chance to showcase their work through
posters, brief lightning talks, or technical presentations.
Feedback will be obtained from attendees using an electronic survey form using SurveyMonkey
as a collection tool (See Attachments A and B). The purpose of this information collection is to
gather information needed for the improved coordination of the 2018 Place & Health Conference
(formerly GIS Day) and to increase the visibility of that event. The information collected will be
used to learn from the success and opportunities from the event, identify areas to improve and
grow the event, and ways to help with event planning for next year.
By knowing which previous Place & Health Conference events were enjoyed and which could be
improved upon will help the planning committee tailor next year’s event to maximize participant
satisfaction. Higher satisfaction will, hopefully, not only improve the visibility of GIS and
GRASP at CDC, but also increase attendance at future Place & Health Conferences.

DESCRIPTION OF RESPONDENTS:
Respondents will be GIS stakeholders from both within and outside of CDC who have attended
the 2018 Place & Health Conference. This includes individuals interested in geospatial
technology/methodology, such as CDC researchers, CDC administrators, academia, students, and
local governmental officials and employees.

TYPE OF COLLECTION: (Check one)
[ ] Customer Comment Card/Complaint Form
[ ] Usability Testing (e.g., Website or Software
[] Focus Group

[ ] Customer Satisfaction Survey
[ ] Small Discussion Group
[X] Other: Event feedback form. _______

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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.
Digitally signed by Padmaja
Padmaja
Vempaty -S
Date: 2018.10.05 10:48:34
Vempaty -S
Name:__________________________________________________________________
-04'00'

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 [ ] No
Gifts or Payments:
Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to
participants? [ ] Yes [X] No
Survey responses will be anonymous via an online survey tool (SurveyMonkey.com). No email,
name, or other identifying information will be collected or stored.

BURDEN HOURS
Category of Respondent

Burden

Event attendee

No. of
Participation
Respondents Time
100
5 min

Totals

100

8

5 min

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FEDERAL COST: The estimated annual cost to the Federal government is $300
This cost reflects approximately 8.3 hours of salary for one staff person (GS-11 equivalent) to
take the survey. 8.3 hours x $36/hour = $300
https://www.fedweek.com/pay-tables/2018-gs-pay-table-atlanta-athens-clarke-countysandy-springs-ga-al/
If you are conducting a focus group, survey, or plan to employ statistical methods, please
provide answers to the following questions:

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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 will be provided from those who register, attend, and sign into the 2018 Place & Health
Conference.

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.

Instructions for completing Request for Approval under the “Generic
Clearance for the Collection of Routine Customer Feedback”
TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the
subject of the request. (e.g. Comment card for soliciting feedback on xxxx)
PURPOSE: Provide a brief description of the purpose of this collection and how it will be used.
If this is part of a larger study or effort, please include this in your explanation.
DESCRIPTION OF RESPONDENTS: Provide a brief description of the targeted group or
groups for this collection of information. These groups must have experience with the program.
TYPE OF COLLECTION: Check one box. If you are requesting approval of other
instruments under the generic, you must complete a form for each instrument.
CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the
collection will be returned as improperly submitted or it will be disapproved.
Personally Identifiable Information: Provide answers to the questions.

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Gifts or Payments: If you answer yes to the question, please describe the incentive and provide
a justification for the amount.
BURDEN HOURS:
Category of Respondents: Identify who you expect the respondents to be in terms of the
following categories: (1) Individuals or Households;(2) Private Sector; (3) State, local, or tribal
governments; or (4) Federal Government. Only one type of respondent can be selected.
No. of Respondents: Provide an estimate of the Number of respondents.
Participation Time: Provide an estimate of the amount of time required for a respondent to
participate (e.g. fill out a survey or participate in a focus group)
Burden: Provide the Annual burden hours: Multiply the Number of responses and the
participation time and divide by 60.
FEDERAL COST: Provide an estimate of the annual cost to the Federal government.
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. Please provide a description of how you plan to
identify your potential group of respondents and how you will select them. If the answer is yes,
to the first question, you may provide the sampling plan in an attachment.
Administration of the Instrument: Identify how the information will be collected. More than
one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or
facilitators (e.g., for focus groups) used.
Please make sure that all instruments, instructions, and scripts are submitted with the
request.

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