Survey Application USJCP

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0925-0648; Exp: 03/2018)

T ITLE OF INFORMATION COLLECTION: US-Japan Cooperative Medical Sciences Program (USJCMSP) 50^th Anniversary and 18^th International Conference on Emerging Infectious Diseases in the Pacific Rim

PURPOSE:

The Office of Global Research (OGR) of the National Institute of Allergy and Infectious Diseases (NIAID) sponsors conferences around the world, and will be sponsoring a conference in Bethesda, Maryland on January 11 – January 15, 2016. NIAID is interested in knowing the participant’s overall satisfaction with what they learned at the conference. This survey is part of a customer satisfaction assessment to examine the NIAID’s conference and workshop implementation and grantees’ perceptions to date. The information collected will enable the Office of Global Research to improve future conferences.

DESCRIPTION OF RESPONDENTS:

Potential survey respondents are the participants of the US-Japan Cooperative Medical Sciences Program (USJCMSP) 50^th Anniversary and 18^th International Conference on Emerging Infectious Diseases in the Pacific Rim, including both American scientists and scientists from Japan and the Asia-Pacific region. We are expecting more than 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: Tatyana E Yeremina (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

BURDEN HOURS

Category of Respondent	Type of from	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)	EID survey (electronic or paper)	150	1	15/60	38h
Totals		150	1	15/60	38h

FEDERAL COST: The estimated annual cost to the Federal government is a $11,193 one-time cost.

*Cite source per bls.gov if applicable

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 USJCMSP during the conference, with an option for paper or web-based submission. 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 more than 150 non-FTE participants at the conference. The surveys will be administered and collected by Tatyana Yeremina.

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

[X] In-person

[ ] Mail

[ ] Other, Explain

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

3