Fast track request for DDM Seminar Survey

Fast Track Clearance Application_DDM Seminar Survey.docx

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

Fast track request for DDM Seminar Survey

OMB: 0925-0648

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Shape1 Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0925-0648 Exp., date: 05/2021)

TITLE OF INFORMATION COLLECTION: Deputy Director for Management (DDM) Seminar Series Survey


PURPOSE: To receive participant feedback of a Deputy Director for Management (DDM) Seminar Series.

The survey collects information on the following:

  • Name and date of seminar

  • Method of attendance

  • Institute/Center/office/community of participant

  • Seminar and speaker feedback

  • Likelihood of attending a future session

  • Suggestions for the seminar series


DESCRIPTION OF RESPONDENTS: Respondents consist of the National Institute of Health community that attend the DDM Seminar Series. An overwhelming portion of participants are Federal Employees but Commission Corps, Volunteers, Fellows, and Contractors may also attend the sessions.



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.


Shima Daneshpour

Shape3 Name:


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

  1. 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



ESTIMATED BURDEN HOURS and COSTS


Category of Respondent

No. of Respondents

No. of Responses per Respondent

Time per Response (in hours)

Total Burden Hours

Federal Government Contractors

35

1

4/60

2






Totals


35


2



Category of Respondent

Total Burden Hours

Hourly Wage Rate*

Total Burden Cost

Federal Government Contractors

2

$31.54

$63.08





Totals



$63.08

https://www.bls.gov/oes/current/oes_nat.htm


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

$280.98





Staff



Grade/Step



Salary*


% of Effort

Fringe (if applicable)

Total Cost to Gov’t

Federal Oversight






NIHTC Program Manager


GS 13/5


$112, 393


0.25%



$280.98







Contractor Cost












Travel






Other Cost












Total





$280.98

*the Salary in table above is cited from 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


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?


The survey will be distributed to all staff who register in the Learning Management System and attend the session. Participation in the survey is voluntary.



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, Paper Evaluations distributed after class

  1. Will interviewers or facilitators be used? [ ] Yes [ x ] No


Please make sure that all instruments, instructions, and scripts are submitted with the request.

2


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleGeneric Clearance Submission Template
SubjectGeneric Clearance Submission Template
AuthorOD/USER
File Modified0000-00-00
File Created2021-04-23

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