Fast track template CPFP Follow-Up Summer Curriculum

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0925-0642, Expiration Date: 05/31/2020)

TITLE OF INFORMATION COLLECTION: NCI CPFP Follow-Up Summer Curriculum Survey

PURPOSE: The purpose of the Division of Cancer Prevention’s Cancer Prevention Fellowship Program (CPFP) Follow-up Summer Curriculum Survey is to assess the impact of the course on the participants to better inform the design of the following year’s NCI Summer Curriculum. All Cancer Prevention Fellows are required to attend the NCI Summer Curriculum during their first full summer at NCI. The survey will be administered approximately three months following the completion of the Summer Curriculum in 2018 and 2019. This survey will be administered to different participants from the Summer Curriculum program in 2018 and 2019. The Summer Curriculum includes two courses: The Principles and Practice of Cancer Prevention and Control course (the Principles Course) and the Molecular Prevention course (the Molecular Course). 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:

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:_____Hala Azzam___________________________________________

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 [] N/A

3. 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	150*	1	5/60	13
Totals	150	150		13

*It is estimated there will be 75 different participants per Summer Curriculum Program, and this survey will be administered over two summers (2018 and 2019).

Category of Respondent	Total Burden Hours	Wage Rate**	Total Burden Cost
Individuals	13	$40.01	$520.13
Totals	13		$520.13

**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 $1,260.62.

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					$0
Total					$1,260.62

***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

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

The respondent list will be participants who attended and completed the CPFP Summer Curriculum in 2018 and 2019. An email will be sent to the participants requesting they complete and return 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 (Survey Monkey)

[ ] Telephone

[ ] In-person

[ ] Mail

[] Other, Explain (hard copy of the survey)

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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