TITLE OF INFORMATION COLLECTION:
PURPOSE: The purpose of the Division of Cancer Prevention’s Cancer Prevention Fellowship Program (CPFP) Daily Summer Curriculum Survey confirms the course objectives are being met and utilize participants’ feedback to better inform the design of the following year’s NCI Summer Curriculum. All Cancer Prevention Fellows are required to attend the National Cancer Institute (NCI) Summer Curriculum during their first full summer at NCI. The Daily Summer Curriculum consists of 3 different lectures or group activities per day, over the course of 5 weeks (i.e., the length of the Summer Curriculum). Feedback based on these surveys are used to determine the activity and speaker list for the following summer, which is subsequently reviewed by administration. Additional details about the program can be found at: https://cpfp.cancer.gov/
DESCRIPTION OF RESPONDENTS:
The respondents to the survey will include general scientific community worldwide as well as Cancer Prevention Fellows (postdoctoral fellows).
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:
The collection is voluntary.
The collection is low-burden for respondents and low-cost for the Federal Government.
The collection is non-controversial and does not raise issues of concern to other federal agencies.
The results are not intended to be disseminated to the public.
Information gathered will not be used for the purpose of substantially informing influential policy decisions.
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:______Hala Azzam__________________________________________
To assist review, please provide answers to the following question:
Personally Identifiable Information:
Is personally identifiable information (PII) collected? [ ] Yes [ X] No
If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No [ ] N/A
If Applicable, has a System or Records Notice been published? [ ] Yes [ ] No [ ] N/A
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 |
75 |
25* |
5/60 |
156 |
|
|
|
|
|
Totals |
75 |
1,875 |
|
156 |
*This same form will be used over 25 separate training/speaker days.
Category of Respondent
|
Total Burden Hours |
Wage Rate*** |
Total Burden Cost |
Individuals |
156 |
$40.01 |
$6,241.56 |
|
|
|
|
Totals |
156 |
|
$6,241.56 |
***Median hourly wage for Social Scientists and Related Workers, All Others (19-3099); https://www.bls.gov/oes/current/oes_nat.htm#19-0000
FEDERAL COST: The estimated annual cost to the Federal government is $2,260.62.
Staff |
Grade/Step |
Salary**** |
% of Effort |
Fringe (if applicable) |
Total Cost to Gov’t |
Federal Oversight |
|
|
|
|
|
Program Lead |
13/10 |
$126,062 |
1% |
|
$1,260.62 |
|
|
|
|
|
|
|
|
|
|
|
|
Contractor Cost |
|
|
|
|
$0 |
|
|
|
|
|
|
Travel |
|
|
|
|
$0 |
Other Cost (Summer Intern) |
|
|
|
|
$1,000 |
|
|
|
|
|
|
Total |
|
|
|
|
$2,260.62 |
****https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2018/DCB.pdf
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
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
The respondent list will be participants who attended and completed the CPFP Summer Curriculum in 2018 and 2019.
Administration of the Instrument
How will you collect the information? (Check all that apply)
[ ] Web-based or other forms of Social Media
[ ] Telephone
[ ] In-person
[X] Other, Explain. The surveys are paper-and-pencil surveys.
Will interviewers or facilitators be used? [ ] Yes [ X ] No
Please make sure that all instruments, instructions, and scripts are submitted with the request.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | Generic Clearance Submission Template |
Subject | Generic Clearance Submission Template |
Author | OD/USER |
File Modified | 0000-00-00 |
File Created | 2021-01-20 |