Fast Track Memo

Request for Approval under the “Generic Information Collection Request for Health Resources and Services Administration Stakeholder Gatherings” (OMB Control Number: 0906-0104)

TITLE OF INFORMATION COLLECTION: 1) Registration information and activity feedback from participants of meetings and workshops.

PURPOSE: To assist with preparing for, and evaluating the reach and effectiveness of, select meetings and workshops conducted by HRSA’s Office of Intergovernmental and External Affairs.

DESCRIPTION OF RESPONDENTS: Health and human service staff from a variety of health and human service organizations (listed on the registration form), such as colleges, community-based organizations, health departments, and hospitals, who attend or participate in select meetings and workshops conducted by HRSA’s Office of Intergovernmental and External Affairs that are designed to promote HRSA’s resources and advance HRSA’s priorities. Staff include a diversity of health and human service positions (listed on the registration form), for instance nurses, social workers, administrators, educators, and home visitors.

TYPE OF COLLECTION:

[X] Registration Form/Application Form [X] Customer Satisfaction Survey

[ ] Customer Comment Card/Complaint Form [ ] Small Discussion Group

[ ] Test of Knowledge [ ] Other:

[ ] Focus Group

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: Robert McKenna ([email protected]) and Richard Overcast ([email protected]).

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

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [X] Yes [ ] No

2. If yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [X] No

3. If yes, has an up-to-date System of Records Notice (SORN) 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

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden Hours Total
Meeting and Workshop Registrants - Registration	1,350	2 minutes ea	45 hours (2,700 minutes)
Meeting and Workshop Participants – Post-Activity Form	900	5 minutes ea	75 hours (4,500 minutes)
Meeting and Workshop Participants – Follow-Up Form	450	4 minutes ea	30 hours (1,800 minutes)
Totals	2,700		150 hours (9,000 minutes)

FEDERAL COST:

The estimated annual cost to the federal government is $2,117.27 annually, for project management, data management, and project administration.

Calculation:

• $1412.46 = An estimated 6 hours annually, or 30 minutes per month, of two GS14, Step 9 staff in the following locations:

  • Kansas City, MO (1): $75.33 per hour (x1.5 = 112.995/hr) x 6 hours = $677.97

  • Philadelphia, PA (1): $81.61 per hour (x1.5 = 122.415/hr) x 6 hours = $734.49

• $704.81 = An estimated 45 minutes annually (15 minutes per event x 3 events) of 10 GS13, Step 5 staff in the following locations:

  • Boston, MA (1): $63.44 per hour (x1.5 = 95.16) x 0.75 hours = $71.37

  • New York, NY (1): $65.97 per hour (x1.5 = 98.955) x 0.75 hours = $74.22

  • Philadelphia, PA (1): $61.79 per hour (x1.5 = 92.685) x 0.75 hours = $69.51

  • Atlanta, GA (1): $59.34 (x1.5 = 89.01) x 0.75 hours = $66.76

  • Chicago, IL (1): $62.69 per hour (x1.5 = 94.035) x 0.75 hours = $70.53

  • Dallas, TX (1): $61.01 per hour (x1.5 = 91.515) x 0.75 hours = $68.64

  • Kansas City, MO (1): $57.04 per hour (x1.5 = 85.56/hr) x 0.75 hours = $64.17

  • Denver, CO (1): $62.43 per hour (x1.5 = 93.645) x 0.75 hours = $70.23

  • San Francisco, CA (1): $69.90 per hour (x1.5 = 104.85) x 0.75 hours = $78.64

  • Seattle, WA (1): $62.88 per hour (x1.5 = 94.32) x 0.75 hours = $70.74

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions: N/A

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 [ ] 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?

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[X] Web-based or other forms of Social Media

[X] Telephone

[ ] In-person

[X] Mail (e-mail)

[X] Other, Explain

Description: Administration of the registration instrument will be in advance of, or in the beginning of, a meeting or workshop. Administration of the post-activity instrument will be immediately at the end of a meeting or workshop. Administration of the participant follow-up form will be approximately 3-6 months after participants have returned to their workplace. Instruments will be shared with intended respondents using the application of Microsoft Forms (95%) or in Portable Document Format (PDF) (5%). Solicitation will be through e-mail (newsletters, e-blasts, and strategic correspondence), text to mobile phones (while participants are still participating in in-person), and links posted in virtual events (also while participants are still participating in activity). Instruments in Microsoft Forms will be accessed by recipients through a URL or QR code, generated by HRSA IEA staff, which will lead to an online form for completion. Instruments in PDF will be e-mail attachments, which recipients can print, complete, scan, and return through e-mail. Responses will be stored in a central repository housed in SharePoint, where data will be retrievable by event (and not PII). When further information about responses could be helpful, a small number of responders who provide permission to be contacted by telephone will receive calls from IEA staff and asked to clarify or elaborate on their responses.

2. Will interviewers or facilitators be used? [ ] Yes [X] No

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