G404 Women in IP Symposium Survey Submission Request

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0651-0080)

TITLE OF INFORMATION COLLECTION: G404: Women in IP Symosium Survey

PURPOSE: The USPTO co-hosts a symposium with the Canadian Intellectual Property Office (CIPO) and other international IP offices to discuss the advancement of women in the innovation/intellectual property economy. The purpose of this survey is to ask attendees their thoughts on the symposium. The survey is hosted by CIPO, but the USPTO is the joint sponor of the event and the two offices are sharing feedback regarding the event itself. USPTO will provide a link to CIPO’s survey via QR code.

DESCRIPTION OF RESPONDENTS: Respondents will be members of international IP offices who attend the symposium.

TYPE OF COLLECTION: (Check one or multiple)

[ ] 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.

Business Unit: _________/Sharon Watson/IOA________________

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

Personally Identifiable Information:

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

1a. If Yes, is the information that will be collected included in records that are subject to

the Privacy Act of 1974? [ ] Yes [X] No

2. If applicable, has a System of 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

BURDEN HOURS

Name of Instrument	No. of Respondents	Participation Time	Burden
Survey – Federal Government	75	15 minutes	19
Totals	75	- - -	19 hours

The USPTO estimates that 100% of the surveys (small discussions, focus groups, etc.) will be conducted electronically.

FEDERAL COST: There is no estimated annual cost to the Federal government. CIPO will received and analyze all responses.

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? [ ] Yes [X] 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?

Attendees will be offered to take part in CIPO’s survey via a QR code displayed at the symposium. Addtionally, a week after the event, attendees will be sent an email inviting them to take the survey if they haven’t already.

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: live poll software

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

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