fast track for NIH Gender-Affirming Care

2023 Fast Track_SGMRO_NIH Scientific Workshop on Gender-Affirming Care Customer Feedback.docx

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

fast track for NIH Gender-Affirming Care

OMB: 0925-0648

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

Shape1 TITLE OF INFORMATION COLLECTION: NIH Scientific Workshop on Expanding the Evidence Base in Gender-Affirming Care for Transgender and Gender-Diverse Populations – Customer Feedback (SGMRO/OD)


PURPOSE:

The National Institutes of Health (NIH) is holding a virtual NIH Scientific Workshop on Expanding the Evidence Base in Gender-Affirming Care for Transgender and Gender-Diverse Populations. The purpose of the workshop is to advance our understanding of transgender health. The Sexual & Gender Minority Research Office wishes to collect feedback from participants of the scientific Workshop. Responses will be used to enhance the planning of future workshops at NIH.



DESCRIPTION OF RESPONDENTS:

The workshop participants are invited researchers, advocates, and members of the community with expertise in transgender health, measurement, behavioral and social sciences, and other disciplines related to the NIH mission. The workshop assessment is limited to the co-chairs, panelists, and NIH staff, which is approximately 60.



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: ______________________



FREQUENCY OF REPORTING: (Check one)


[X] Once [ ] Quarterly

[ ] Monthly [ ] On Occasion

[ ] Annually [ ] 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:_ Irene Avila, PhD ([email protected]; 301-594-9701)


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



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

60

1

5/60

5






Totals


60


5


COST TO RESPONDENT


Category of Respondent


Total Burden

Hours

Hourly Wage Rate*

Total Burden Cost

Individuals

5

$51

$255





Totals

5


$255

* https://www.bls.gov/oes/current/oes_47900.htm#19-0000


FEDERAL COST: The estimated annual cost to the Federal government is ___$241


Staff


Grade/Step

Salary*

% of Effort

Fringe (if applicable)

Total Cost to Gov’t

Federal Oversight






Assistant Director

GS-15-2

$ 160,889

0.15%


241













Contractor Cost












Travel






Other Cost












Total





$241

*the Salary in table above is cited from https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/2023/general-schedule


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 SGMRO will send an email to ask workshop participants to complete the electronic feedback form (https://survey.alchemer.coms/s3/7220761/) at the end of the meeting.


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

  1. 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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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleGeneric Clearance Submission Template
SubjectGeneric Clearance Submission Template
AuthorOD/USER
File Modified0000-00-00
File Created2023-08-26

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