fast track for GFH2R feedback survey

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0925-0648 Exp., date: 06/30/2024)

TITLE OF INFORMATION COLLECTION: Global Forum on Humanitarian Health Research (GFH2R) Feedback Survey

PURPOSE:

The Global Forum on Humanitarian Health Research (GFH2R) is an online event organized by the Fogarty International Center of NIH, in partnership with the International Development Research Centre (IDRC), UK Medical Research Council (MRC), and Wellcome Trust. The meeting brings researchers and humanitarian organizations together to share experiences and promote collaboration around health research in humanitarian settings. Participants and case study presenters were selected by a steering committee who will participate in several virtual sessions between November 8-18, 2021. The meeting is being hosted by CRDF Global.

The Feedback Survey will be offered to all participants through an online form hosted by CRDF Global. The survey will be used to assess how well the event achieved its goals.

DESCRIPTION OF RESPONDENTS:

Respondents will be the participants of GFH2R from academic institutions, NGOs, governments, and research funding agencies. The majority are from low- and middle-income countries around the world and all are English-speaking.

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:___Amit Mistry_____________________________________________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ X ] Yes [ ] 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

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	130	1	10/60	22
Totals		130		22

COST TO RESPONDENT

Category of Respondent	Total Burden Hours	Hourly Wage Rate*	Total Burden Cost
Individuals – American - 30	5	$59	$295
Individuals – International (mostly low- or middle-income countries) - 100	17	$32	$544
Totals			$839

*Source: Bureau of Labor Statistics: The General Public rate was obtained from https://www.bls.gov/oes/current/oes251071.htm. For American Respondents only.

FEDERAL COST: The estimated annual cost to the Federal government is ___281.41______

Staff	Grade/Step	Salary*	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Health Science Policy Analyst	13 / 9	$131,341	1%		$131.41
Contractor Cost
Contractor		$15000	1%		$150
Travel
Other Cost
Total					$281.41

*the Salary in table above is cited from https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2020/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? [ ] Yes [ X ] 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?

Any participant that attended one or more sessions of GFH2R will be able to access and complete the survey. Our respondents are only the participants in the online event and since they were all hand selected by the Steering Committee, we can control who will be able to respond to the survey request.

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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