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Template 2023 Fast Track_NIH SGM Health Summer Intensive Series Final Session Customer Feedback.docx

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

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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 Sexual & Gender Minority (SGM) Health Summer Intensive Series Customer Feedback -Final Session


PURPOSE:

The Sexual & Gender Minority Research Office (SGMRO) wishes to collect feedback from participants of the NIH Sexual & Gender Minority Health Summer Intensive Series (SGM SIS). The goal of the SGM SIS is to enhance the learning of trainees about SGM health research and its intersection with science, policy, communication, and community engagement. For the final session, SGMRO would like feedback on the final session and the overall series. The SGM SIS participants will include summer interns, postbacs, predocs, postdocs, and NIH staff, who are interested in SGM health. The responses will be used to improve and expand the program for future participants.


DESCRIPTION OF RESPONDENTS:

Respondents are participants of the SGM SIS, which includes summer interns, postbacs, predocs, postdocs – who are trainees at the NIH Intramural Research Program and extramural academic institutions, as well as NIH staff.


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

50

1

10/60

8






Totals


50


8


COST TO RESPONDENT


Category of Respondent


Total Burden

Hours

Hourly Wage Rate*

Total Burden Cost

Individuals

8

$51

$408





Totals



$408

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


FEDERAL COST: The estimated annual cost to the Federal government is ___$488


Staff


Grade/Step

Salary*

% of Effort

Fringe (if applicable)

Total Cost to Gov’t

Federal Oversight






Assistant Director

GS-15-2

$155,886

0.15%


$234

Program Officer

GS-13-5

$126,949

0.2%


$254







Contractor Cost












Travel






Other Cost












Total





$488

*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 session participants who registered to complete the electronic feedback form at the end of each session. We expect approximately 50 trainees to register for the SGM SIS. Thus, we expect approximately 50 respondents.



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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