LRP Ambassador Feedback

LRPAmbassador Feedback Fast Track OMB Form - ML 10-26-2016.doc

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

LRP Ambassador Feedback

OMB: 0925-0648

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Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0925-0648 Exp Date: 03/31/2018)

T ITLE OF INFORMATION COLLECTION: LRP Ambassador Feedback


PURPOSE: To obtain feedback from Loan Repayment Program (LRP) Ambassadors about their activities reaching out to prospective applicants.


DESCRIPTION OF RESPONDENTS: Respondents will be individuals who have voluntarily agreed to be LRP Ambassadors, i.e., individuals who provide outreach about the NIH Loan Repayment Programs to prospective applicants at their institutions.


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: Ericka Boone, Ph.D.


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? [x] 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

Individual

1350

1

10/60

225






Totals

1350

1350


225



Category of Respondent


Total Burden

Hours

Hourly Wage Rate*

Total Burden Cost

Individuals

225

$39.54*


$8,896.05





Totals

225


$8,896.05


* Median Pay for Medical Scientists per BLS Occupational Handbook (http://www.bls.gov/ooh/life-physical-and-social-science/medical-scientists.htm)



FEDERAL COST: The estimated annual cost to the Federal government is $16,100.


Staff


Grade/Step

Salary

% of Effort

Fringe (if applicable)

Total Cost to Gov’t

Federal Oversight






Ericka Boone

15-1

$175,000

2%


$3,500













Contractor Cost






One Contractor

n/a

$180,000

7%


$12,600

Travel





None

Other Cost





None







Total





$16,100




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


Previous and current LRP awardees (approximately 9000 individuals) will be invited by email to serve as LRP Ambassadors. A 15 percent response rate is anticipated, based on the response rate to a previous invitation, i.e., 1350 individuals. Those who choose to become Ambassadors will be asked annually at the end of the LRP application cycle period to comment on the number of outreach activities they conducted with prospective applicants.


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

  1. Will interviewers or facilitators be used? [ ] Yes [x] No



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File Typeapplication/msword
File TitleGeneric Clearance Submission Template
SubjectGeneric Clearance Submission Template
AuthorOD/USER
Last Modified ByFountain, Marisa (NIH/OD) [E]
File Modified2016-10-26
File Created2016-10-26

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