Fast Track substudy for Nonprofit Forum

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0925-0648 Exp Date: 05/2021)

T ITLE OF INFORMATION COLLECTION: 2019 Nonprofit Forum on-site meeting feedback

PURPOSE: The purpose of this information collection is to collect participant feedback (e.g., feedback on content, format, and relevance) from the 2019 Nonprofit Forum attendees. Meeting attendees have the option of attending various plenary and breakout sessions and submit their evaluations of these sessions. Submitted information will be reviewed by internal NIH committees responsible for planning the Forum content, breakout activities and will be used to identify future speakers/panelists. The information may also be used to create a resource for future collaborations.

DESCRIPTION OF RESPONDENTS: Respondents are meeting registrants including National Institutes of Health (NIH), Food and Drug Administration (FDA), industry and 75 different nonprofit organizations across the country who will attend the NIH sponsored 2019 Nonprofit Forum in the Neuroscience Center (6001 Executive Boulevard First Floor Conference Rooms) in Rockville, Maryland. The survey form is the same for all meeting 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: Sophia Jeon, Ph.D. Health Science Policy Analyst, NINDS OSPP

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

Personally Identifiable Information:

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

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ x] 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
Individual	200	1	10/60	33
Totals	200	200		33

Category of Respondent	Total Burden Hours	Wage Rate*	Total Burden Cost
Individual	33	$38.56	$1,272.48
Totals			$1,272.48

*Hourly wage rates for 19-1029 Biologic Scientist is $38.56 (based on http://www.bls.gov/oes/current/oes191029.htm).

FEDERAL COST: The estimated annual cost to the Federal government is $15,454.15

Staff	Grade/Step	Salary**	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight:
Technical Writer/editor	11/1	$68,036.00	20%		$13,607.20
Contractor Cost (optional):
Contractor 1		$12,313.00	15%		$1,846.95
Travel (optional)
Other Cost (optional)
Total					$15,454.15

**The salary in the table above is cited from https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/18Tables/html/DCB.aspx

The selection of 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?

Federal staff are comprised of federal employees and/or contractors who support their agency’s contribution to the Nonprofit Forum and are self-identified at each agency. For nonprofit organizations, lists of groups likely interested and/or invested in the Forum will be referenced. These lists are held by the NINDS communications office and recommendations from other federal agencies will be requested. For additional questions, please contact Jessica Corley (Jessica.corley@nih.gov).

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

[ ] Survey form

[ ] Chart Abstraction

[ ] Other, Explain

2. Will interviewers, facilitators, or research coordinators be used? [ ] Yes [x] No

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

File named “2019 NINDS Non-profit Forum meeting feedback survey” is attached along with this template

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