Request for Approval

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 [ ] 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 [ ] 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 [ ] 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 [ ] 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 [ ] 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.

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

TITLE OF INFORMATION COLLECTION: 2020 Science Ambassador Application Survey

PURPOSE:

The Centers for Disease Control and Prevention (CDC) seeks to obtain Office of Management and Budget (OMB) approval to collect feedback for the application process for Science Ambassador Fellowship class of 2020. The CDC Science Ambassador Fellowship is an educational program for Science, Technology, Engineering, and Math (STEM) teachers and educational leaders interested in bringing public health sciences into middle- and high-school classrooms. This fellowship includes a 5-day interactive summer course at CDC headquarters in Atlanta, Georgia, and a 1-year distance-based professional development opportunity.

Applicants apply through an online application system, which requires applicants to gather materials (e.g., a letter of recommendation) and information (e.g., work and volunteer experience). Submitted applications undergo an eligibility review and application reviews before selecting a final cohort.

In 2020, there were fewer overall applications submitted for the Science Ambassador class of 2020. The goal of this survey is to understand the reasons why potential Science Ambassador applicants started but did not submit an application. This information collection will be used by the Science Ambassador Fellowship to refine the application process and provide recommendations to improve fellowship recruitment processes.

DESCRIPTION OF RESPONDENTS:

Respondents to the 2020 Science Ambassador Application Survey (Attachment 1, Survey Word document and Attachment 2, Survey Screenshots) will be the Science Ambassador class of 2020 applicants who started but did not submit an applicant and who provided an email address. No personally identifiable information (PII) will be collected; should any respondents provide PII, it will not be retained.

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: Kelly L Cordeira, MPH

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 [x] 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

The survey will be web-based and includes 9 questions. Respondents will take approximately 10 minutes to complete the survey through Survey Monkey. This estimate is based on piloting the survey with three CDC staff. We are seeking approval to collect feedback from approximately 90 non-federal individuals (i.e., middle school, high school, community college professors, and other educators). Given 90 respondents with a response time of 10 minutes each, the total response burden will be 15 hours. There will be no direct costs to the respondents other than their time to respond to the survey.

Category of Respondent	No. of Respondents	Participation Time	Burden
Individuals	90	10/60	15 hours
Totals

FEDERAL COST:

The average annualized cost to the Federal Government to collect this information is $1,001.10. This estimate is based on the time required for one FTE (GS-13) to supervise and for one Fellow (GS-9 Equivalent) to design the survey, develop the web-based survey, implement the survey, analyze the data, and develop recommendations based on the results.

Staff or Contractor	Hours	Average Hourly Rate	Cost
Fellow (GS-9 Equivalent): survey design, create web-based survey, implementation, analysis, and reporting	30	$26.71	$801.30
FTE Supervisor (GS-13)	5	$46.06	$ 230.30
Totals			$1031.60

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

The individuals who started but did not submit an SAF application for the 2020 class will be invited to participate in the 2020 Science Ambassador Application Survey. By March 2020, an invitation email (Attachment 3, Invitation Email) with a link to the survey will be sent to the applicants for the SAF Class of 2020 (1) who started but did not submit an application, and (2) who provided an email address. Respondents will be given 3 weeks to respond to the survey. Respondents will have to complete the survey in one sitting as the survey tool does not allow respondents to return to edit or complete the survey. The survey does not track individual responses. A reminder email (Attachment 4, Reminder Email) will be sent three times: one email at the beginning of week 1, one email at the beginning of week 2, and the final email on the day the survey closes.

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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