GenIC Fasttrack Template

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-1071)

TITLE OF INFORMATION COLLECTION:

Customer Satisfaction Survey for 2018 UNGA AMR Side Event

PURPOSE:

The U.S. Government and Centers for Disease Control and Prevention will capture feedback regarding participant experience at the 2018 United Nations General Assembly (UNGA) AMR side event, what can be done to improve future events, and where participating organizations will make a commitment to combat antimicrobial resistance. This survey comes one day after the 2018 UNGA AMR side event on Sept. 25, 2018 to launch The AMR Challenge, a yearlong effort to accelerate the fight against antimicrobial resistance with action across governments and industries. Results may inform ways CDC can enhance future events as well as understand where industries will be leading in the fight against antimicrobial resistance.

DESCRIPTION OF RESPONDENTS:

Respondents will be those who attended the 2018 UNGA AMR side event on Sept. 25, 2018. Respondents represent leaders from government and industry, including Academic Institutions and Centers; Agriculture, Meat, and Livestock Associations; Animal and Veterinary Associations; Clinical and Medical Associations; Consumer and Patient Advocates; Digital Platforms, Employers, Environmental and Sanitation Associations; Food Producers and Retailers; Funders; Health IT Companies; Health Payers; Health Insurance Companies; Health Systems; Long-Term Care; Pharmacies; Infrastructure and Utilities; Intergovernmental Organizations; Laboratories, Media and Public Relations; Non-US Governments and Municipalities; Pharmaceuticals, Diagnostics, Vaccines, Standards and Accreditation Bodies

Therapeutics; US Federal Government; and US State and Local Government.

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: Michael C. Craig, MPP

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

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Private sector	300	5 minutes	25 hours
Totals			25 hours

FEDERAL COST: The estimated annual cost to the Federal government is $1,200 (1 Contractor for 10 hours)

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?

We will use the 2018 UNGA AMR side event invitation list for distribution of the survey.

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.

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