Template Information

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-1050)

Instruction: This form should be completed by the primary contact person from the Program sponsoring the collection.

DETERMINE IF YOUR COLLECTION IS APPROPRIATE FOR THIS GENERIC CLEARANCE MECHANISM:

Instruction: Before completing and submitting this form, determine first if the proposed collection is consistent with the scope of the Collection of Routine Customer Feedback generic clearance mechanism. To determine the appropriateness of using the Collection of Routine Customer Feedback generic clearance mechanism, complete the checklist below.

If you select “yes” to all criteria in Column A, the Collection of Routine Customer Feedback generic clearance mechanism can be used. If you select “yes” to any criterion in Column B, the Collection of Routine Customer Feedback generic clearance mechanism cannot be used.

Column A	Column B
The information gathered will only be used internally to CDC. [X ] Yes [ ] No	Information gathered will be publicly released or published. [ ] Yes [X ] No
Data is qualitative in nature and not generalizable to people from whom data was not collected. [ X] Yes [ ] No	Employs quantitative study design (e.g. those that rely on probability design or experimental methods) [ ] Yes [X ] No
There are no sensitive questions within this collection (e.g. sexual orientation, gender identity). [X ] Yes [ ] No	Sensitive questions will be asked (e.g. sexual orientation, gender identity). [ ] Yes [X ] No
Collection does not raise issues of concern to any other Federal agencies. [X ] Yes [ ] No	Other Federal agencies may have equities or concerns regarding this collection. [ ] Yes [X ] No
Data collection is focused on determining ways to improve delivery of services to customers of a current CDC program. [X ] Yes [ ] No	Data will be used to inform programmatic or budgetary decisions, for the purpose of program evaluation, for surveillance, for program needs assessment, or for research. [ ] Yes [ X ] No
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. [X ] Yes [ ] No

Did you select “Yes” to all criteria in Column A?

If yes, the Collection of Routine Customer Feedback generic clearance mechanism may be appropriate for your investigation. You may proceed with this form.

Did you select “Yes” to any criterion in Column B?

If yes, the Collection of Routine Customer Feedback generic clearance mechanism is NOT appropriate for your investigation. Stop completing this form now.

TITLE OF INFORMATION COLLECTION: Special Emphasis Panel (SEP) Peer Review Evaluation for Quality Improvement

PURPOSE:

The Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control’s (NCIPC) mission is to prevent violence and injuries through science and action. The Extramural Research Program Operations (ERPO) within the NCIPC is the focal point for the development, peer review, and post award management of extramural research awards for the NCIPC, as well as for the CDC National Center for Environmental Health, and the Agency for Toxic Substances and Disease Registry (ATSDR). At the CDC/ATSDR applications for extramural research funding undergo a sequential, 2-level peer review process. The first level (primary peer review) evaluates the scientific and technical merit of research applications submitted in response to a Notice of Funding Opportunity (NOFO). Primary peer review is a key step in assuring that CDC/ATSDR research grant applications receive a fair and unbiased review by experts with relevant knowledge. Objective review by external scientists helps to ensure CDC funds the most meritorious research possible to achieve its mission. The second level (secondary peer review) examines the mission relevance and programmatic balance of the center’s research portfolio in advancing CDC/ATSDR’s research agenda.

The purpose of this request is to collect timely feedback from peer reviewers who served on a CDC/ATSDR SEP conducted by the NCIPC ERPO to review extramural research applications annually for a three-year period. The constructive feedback will be used to inform our continuous improvement efforts. Qualitative questions about the procedures and processes experienced during the peer review process are also included. The information collected will provide for feedback and assist in identifying areas to improve the experience for scientists who volunteer to serve on CDC/ATSDR SEPs for the NCIPC ERPO. The information collected will also contribute to ongoing efforts to maintain a quality science peer review program. Improvements in the peer review process will enable the ERPO to recruit the best researchers in injury and violence prevention, environmental health, and toxicology in order to provide thorough critiques and advice on the scientific merit of extramural research applications. Without such data collection this information would be unknown.

DESCRIPTION OF RESPONDENTS:

Potential respondents are individuals who were appointed to and served on a CDC/ATSDR SEP conducted by the NCIPC ERPO. The reviewers could include state or local health department staff, public health practitioners, and researchers with expertise in research, program implementation and evaluation for violence and injury prevention programs and strategies.

TYPE OF COLLECTION: (Check one)

Instruction: Please sparingly use the Other category

[ ] 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 and served on a CDC/NCIPC SEP for peer review or may have experience with the peer review program in the future.

Name:_______________Karen Angel_________________________________

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

If Yes: Please describe the incentive. If amounts are outside of customary incentives, please also provide a justification.

BURDEN HOURS

The target respondents will be all members who participated in a Special Emphasis Panel (SEP) peer review panel. The survey will be administered via SurveyMonkey, each feedback response takes an average of 20 minutes to complete (Attachment 1).

Category of Respondent	No. of Respondents	Participation Time	Burden in hours
SEP peer review panelist	500	20/60	167
Totals	500		167

FEDERAL COST: The estimated annual cost to the Federal government is $4,500.

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 Yes: Please provide a description of both below (or attach the sampling plan)

If No: Please provide a description of how you plan to identify your potential group of respondents and how you will select them or ask them to self-select/volunteer?

Customers are individuals who volunteer to serve as a peer reviewer on a CDC/ATSDR Special Emphasis Panel (SEP) conducted by the NCIPC ERPO. Only reviewers who are appointed by the CDC Director and who actually serve on a SEP peer review panel will be respondents. This potential pool of respondents includes state or local health department staff, public health practitioners, and researchers with expertise in research, program implementation and evaluation for violence and injury prevention programs and strategies, opioid overdose and misuse, environmental health, and toxicology. No sampling will be conducted, participants will be provided the feedback form (Attachment 1) by email and will be informed to provide voluntary feedback.

The identity of the participants is not collected or disclosed and only aggregated responses will be used in our analyses. Data collected will be reviewed and analyzed in Excel. Descriptive statistical analysis of quantitative data and thematic analysis of qualitative responses will be conducted. The results of the analysis will be shared internally with the NCIPC ERPO to inform continuous quality improvement of the peer review process and implementation.

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

[X] Other, Explain- Survey Monkey

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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