2434-82 EHD Justification

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 2010-0042)

TITLE OF INFORMATION COLLECTION:

Evaluation Survey for the 2^nd Annual Grantees Meeting of the NIH/EPA Centers of Excellence on Environmental Health Disparities Research.

PURPOSE:

The Office of Research and Development (ORD) National Center for Environmental Research (NCER) is requesting approval to conduct one Meeting Evaluation Survey at the 2^nd Annual Grantees Meeting of the NIH/EPA Centers of Excellence on Environmental Health Disparities Research. NCER would like to collect this data from participants so that it can be used to determine ways the meeting can be more effective in the future.

DESCRIPTION OF RESPONDENTS:

NCER estimates there will be approximately 100 attendees at the meeting this year and that 75% (or 75 participants) will respond to the survey.

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: Maggie Breville

Research Program Manager

National Center for Environmental Research

Office of Research and Development

U.S Environmental Protection Agency

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
Individuals	75	4 minutes per response	5 hours
Totals	75	300 minutes	5 hours

FEDERAL COST: The estimated annual cost to the Federal government is $0.

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

Each meeting participant will receive a copy of the evaluation in their packet of meeting materials. No sampling plans were developed to select respondents.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[ ] Telephone

[x] 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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