fast track for Diversity Supplement Scholars

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: Diversity Supplement Feedback Survey (NCCIH)

PURPOSE:

To gather feedback from the National Center for Complementary and Integrative Health (NCCIH) Diversity Supplement scholars who were awarded their supplement between 2000-2021. We would like identify strengths and weaknesses of the program and help improve the program for future diversity scholars.

DESCRIPTION OF RESPONDENTS:

Respondents are past or current NCCIH grantees who were awarded a Diversity Supplement between 2000-2021. There are 75 invitees.

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: ___Melissa Trevino____

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 [ ] 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
Registered individuals	75	1	10/60	13
Totals		75		13

COST TO RESPONDENT

Category of Respondent	Total Burden Hours	Hourly Wage Rate*	Total Burden Cost
Individuals or Households	13	$31.44	$409.72
Totals			$409.72

*Cited source per bls.gov

https://www.bls.gov/news.release/empsit.t19.htm Used “Education and health services” hourly wage rate

FEDERAL COST: The estimated annual cost to the Federal government is $1,068.23

Staff	Grade/Step	Salary**	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Health Program Specialist	13/1	106,823	1%		$1,068.23
Contractor Cost
Travel
Other Cost
Total					$1,068.23

**the Salary in table above is cited from: https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/22Tables/html/DCB.aspx

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?

We have a list of the 75 Diversity Scholar awardees that we will be our targeted respondents. Respondents are past or current NCCIH grantees who were awarded a Diversity Supplement between 2000-2021.

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

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

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