2019 HDRI Course Assessment Fast Track

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: Health Disparities Research Institute (HDRI) Course Assessment (NIMHD)

PURPOSE: This collection of information is required as part of the assessment of NIMHD’s Health Disparities Research Institute that will take place from August 19-23, 2019. Participants will rate daily speakers and program activities. All responses are anonymous and participation is voluntary. Information obtained from this document will be used to plan future Health Disparities Research Institutes

DESCRIPTION OF RESPONDENTS: Postdoctoral students, assistant professors, early career research investigators, and scientists engaged in minority health and health disparities research who were invited to participate in the Health Disparities Research Institute.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [X ] Other: _Course Assessment___

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: Richard C. Palmer, Dr.PH____

To assist in 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 [X ] 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
Private sector	55	1	10/60	9
Totals		55		9

Category of Respondent	Total Burden Hours	Hourly Wage Rate*	Total Burden Cost
	9	$34.24**	$308.00
Totals			$308.00

*Cite source per bls.gov if applicable

**Life, Physical, and Social Science Occupations, Occupation code 19-0000, mean hourly wage: https://www.bls.gov/oes/current/oes_nat.htm#19-0000

FEDERAL COST: The estimated annual cost to the Federal government is _$956.00___

Staff	Grade/Step	Salary*	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Program Analyst	GS-12/8	$95,570	1%		$956.00
Contractor Cost
Travel
Other Cost
Total					$956.00

*the Salary in table above is cited from https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2018/DCB.pdf

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?

Individuals who have been selected to participate in the Health Disparities Research Institute will be Postdoctoral students, assistant professors, early career research investigators, and scientists. Fifty-five individuals were selected to participate in this year’s institute.

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

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

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