NCEF Fast Track template

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0925-0642 ExpDate:05/2020)

TITLE OF INFORMATION COLLECTION: NCEF Survey for Program Operations

PURPOSE:

The National Cryo Electron Microscopy Facility (NCEF) provides extramural cancer researchers access to the latest cryo-EM technology for high resolution imaging. The purpose of this survey is to gather customer feedback to better service delivery for the NCEF Program. The information gathered will primarily be used within the NCEF and NCI but may also be shared with NCI advisory committees (although comments and responses will not be attributed to individual people).

DESCRIPTION OF RESPONDENTS:

The respondents are 120 users of the NCEF who are extramural scientist that perform cancer related scientific research that requires cryo-EM high resolution imaging data collection of their samples to support their work in producing publications for scientific journals. Scientist include principal investigators, post-doctoral researchers, graduate students, post-baccalaureate students, and lab technicians.

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:_____Sara Hook

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 [X ] 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

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	120	1	3/60	6
Totals	120	120		6

Category of Respondent	Total Burden Hours	Wage Rate*	Total Burden Cost
Individuals	6	$20.80/hr	$124.80
Totals	6		$124.80

*Cite source per bls.gov if applicable: Labor Force Stats. www.bls.gov/cps/cpsaat37.htm

FEDERAL COST: The estimated annual cost to the Federal government is _____$896____

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Project Officer	GS 15	136,000	0.0025		$340
Contractor Cost		95,000	0.0045	$128.25	$556
Travel					0
Other Cost					0
Total					$896

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

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?

NCEF will use the list of customers that the program has provided services to.

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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