Fast-track template

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0925-0668 Exp. Date: 01/2016)

T ITLE OF INFORMATION COLLECTION: The National Institute of Allergy and Infectious Diseases, Pan-American Health Organization, and World Health Organization, Gaps and Opportunities in Chikungunya Research: Expert Consultation on Chikungunya Disease in the Americas

PURPOSE:

The National Institute of Allergy and Infectious Diseases (NIAID) sponsors conferences around the world, and will be co-sponsoring a conference in Rockville, Maryland on June 30 – July 2, 2015 together with the World Health Organization (WHO). NIAID’s Office of Global Research (OGR) is interested in knowing the participant’s overall satisfaction with what they learned at the conference as well as whether the workshop/consultation was successful in identifying gaps and opportunities in research. This survey is part of a customer satisfaction assessment to examine the NIAID’s and WHO’s conference and workshop implementation and attendees’ perceptions to date. The information collected will enable the NIAID and WHO to improve future conferences and encourage collaboration.

DESCRIPTION OF RESPONDENTS:

Potential survey respondents are the participants of the Gaps and Opportunities in Chikungunya Research: Expert Consultation on Chikungunya Disease in the Americas, including both American scientists and scientists from the Americas, Africa, Caribbean, and Europe. We are expecting about 150 non-FTE attendees.

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: Nancy Touchette (DHHS, NIH, NIAID, OD, OGR)

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
Private Sector/ non-USG (Academia, industry, not-for profits, scientists)	150	1	15/60	38h
Totals	150	1	15/60	38h

Category of Respondent	Total Burden Hours	Wage Rate*	Total Burden Cost
Private Sector/ non-USG (Academia, industry, not-for profits, scientists)	38h	$32.66/hour	$1,224.75
Totals	38h		$1,224.75

*Cite source per bls.gov if applicable

FEDERAL COST: The estimated annual cost to the Federal government is a $800 one-time cost.

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight	GS14/10	139,523/annual	1/52		$2,683
	GS14/8	132,368/annual	1/52		$2,545
	GS15/7	151,496/annual	1/52		$2,913
	GS14/9	158,700/annual	1/52		$3,052
Contractor Cost
Travel
Other Cost

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 survey will be provided to all the participants at the Chikungunya Conference, in paper form on the final day of the conference. The survey will also include a question for participants to indicate whether they are government employees or not. The conference registration is not complete; therefore, the list of specific participants is not yet available. We anticipate hosting 150 non-FTE participants at the conference. The surveys will be administered and collected by Tatyana Yeremina, Nancy Touchette, or Mary Fanning.

Administration of the Instrument

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

[ ] Web-based or other forms of Social Media

[ ] Telephone

[X] 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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