Amgen Scholars fast track template

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0925-0648 ExpDate: 05/2021)

T ITLE OF INFORMATION COLLECTION:

NIH Office of Intramural Training & Education (OITE) – Amgen Scholars at NIH Feedback

PURPOSE:

The Amgen Scholars at NIH program is a partnership between Amgen Foundation, the Foundation for the NIH, and the NIH Office of Intramural Training & Education (OITE). Amgen Scholars at NIH spend the summer performing research within the NIH Intramural Research Program as a summer trainee. Participants are exposed to basic, translational, and clinical research as well as participating in journal clubs, case studies, writing projects and other group activities designed to develop communication, career readiness, and critical thinking skills. The program includes a particular focus on health disparities and the science policy involved in their elimination. Additional details about the Amgen Scholars at NIH program may be found by visiting: https://www.training.nih.gov/amgenscholars.

DESCRIPTION OF RESPONDENTS:

The OITE wishes to collect feedback from students participating in the Amgen Scholars at NIH partnership. Responses will be used to enhance and expand the program for future participants. Participants do not receive financial support from the NIH, but rather from a non-federal source.

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: Patricia Wagner, PhD (wagnerpa@od.nih.gov; 240-476-3619)

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

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	20	1	15 / 60	5
Totals	20	20		5

Category of Respondent	Total Burden Hours	Hourly Wage Rate*	Total Burden Cost
Individuals	5	$12.25	$61.25
Totals			$61.25

*Students participating in the Amgen Scholars at NIH receive a stipend from Amgen that equates to $12.25 / hour.

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Federal-1	Title 42	$200,000.00	0.10%	~	$200.00
Federal-2	GS13-S03	$98,289.00	0.10%	~	$99.00
Contractor Cost
Travel	~	~	~	~	~
Other Cost	~	~	~	~	~
Total Cost	~	~	~	~	$299.00

*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

FEDERAL COST: The estimated annual cost to the Federal government is $299.00.

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 OITE will ask all Amgen and NIH Scholar participating in the current year summer program to complete and submit the feedback form.

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 – may use paper format for distribution

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

Collection:

Amgen-Scholars-Feedback.pdf

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