Generic clearance template NIGMS OSR

generic_clearance_template_NIGMS OSR - FINAL5.docx

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

Generic clearance template NIGMS OSR

OMB: 0925-0648

Document [docx]
Download: docx | pdf

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


Shape1 TITLE OF INFORMATION COLLECTION: Customer Satisfaction with the Contribution of Site Visits to Assess Institutional Training Grant Applications


PURPOSE: The Office of Scientific Review (OSR) at NIGMS is conducting an analysis to determine the usefulness of site visits as part of the peer review of institutional training grant applications.  Site visits are performed on a rotating basis by reviewers currently serving on the four NIGMS standing study sections (TWD-A, -B, -C, -D) that review these applications.  OSR proposes to survey reviewers serving on the four TWD study sections for feedback on their experiences during site visits and how satisfied they are with this approach to help assess training grant applications.  The responses from the feedback survey will contribute to determining the level of customer satisfaction amongst reviewers for how peer review is conducted at NIGMS.




DESCRIPTION OF RESPONDENTS: Individuals currently serving on the four NIGMS standing study sections (TWD-A, -B, -C, -D) will be surveyed. These are the individuals that participate in site visits as part of the peer review process and are therefore the customers.




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:_Stephanie L Constant, Ph.D.______________________________________________


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


Personally Identifiable Information:

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



  1. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

  2. 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

Individuals

67

1

10/60

11






Totals

67

67


11



Category of Respondent


Total Burden

Hours

Hourly Wage Rate*

Total Burden Cost

Individuals

11

45

$495





Totals



$495


*Cite source per bls.gov if applicable

Medical scientists - https://www.bls.gov/news.release/pdf/ocwage.pdf



FEDERAL COST: The estimated annual cost to the Federal government is $105_________


Staff


Grade/Step

Salary

% of Effort

Fringe (if applicable)

Total Cost to Gov’t

Federal Oversight






Extramural Support Staff

7/6

$52,434

0.2


$105













Contractor Cost












Travel






Other Cost












Total





$105




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 list of customers we plan to survey are the current members on the four TWD standing review committees. All members from all four committees will be surveyed, so no sampling will be involved.


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

[X] Mail - eMail

[ ] Other, Explain

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

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

















6

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleGeneric Clearance Submission Template
SubjectGeneric Clearance Submission Template
AuthorOD/USER
File Modified0000-00-00
File Created2021-01-22

© 2024 OMB.report | Privacy Policy