fast track for Rural Health Day

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0925-0648 Exp., date: 06/30/2024)

TITLE OF INFORMATION COLLECTION: Customer Satisfaction Survey for Rural Health Day 2021 Seminar (NCCIH)

PURPOSE:

The NIH Rural Health Committee is interested in assessing the efficacy of our annual Rural Health Day event. We plan to reach out to attendees of the 2021 Rural Health Day Seminar to complete an optional post-seminar survey. The purpose of this survey is to gauge the efficacy of the event and its structure (e.g., online platform) and to gauge the interests and topics that attendees hope future Rural Health Day events will direct their focus.

The NIH Rural Health Committee has an interest in whether we are meeting the needs of the Rural Health Day attendees. If there are unmet needs or suggestions, the NIH Rural Health Committee may use these data to shape content and features of future Rural Health Day events. All responses will be kept secure to the extent permitted by law and no identifiers will be collected.

This information will be collected through a standard “form” template and data will be collected and stored in an Excel spreadsheet. The data will be stored on a secure server, with all the standard protocols for keeping information and data private and safe. This project is a small, discreet evaluation effort. The Rural Health Committee will produce a final report with aggregated data.

DESCRIPTION OF RESPONDENTS:

Respondents will only include individuals who registered for the 2021 NIH Rural Health Day Seminar. Previous NIH Rural Health Day seminars have attracted many interested parties including, but not limited to: clinical researchers, public health employees, members of the public, advocates, policymakers, journalists, and NIH Employees.

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:_ Troy Dildine, BA, Pre-doctoral IRTA Fellow, Affective Neuroscience and Pain Lab, NCCIH

_______________________________________________

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
Private sector	942*	1	10/60	157
Totals		942		157

*This number is based on an average from registrations from the last two Rural Health Day events (735 in 2019 and 1,149 in 2020).

COST TO RESPONDENT

Category of Respondent	Total Burden Hours	Hourly Wage Rate*	Total Burden Cost
Medical scientist	157	$48.45	$7,606.65
Totals			$7,606.65

*Source of the mean Hourly Wage Rate is provided by the Bureau of Labor Statistics, Occupation title “Medical Scientists” 19-1040, https://www.bls.gov/oes/2020/May/oes_nat.htm#19-0000.

FEDERAL COST: The estimated annual cost to the Federal government is $473.80

Staff	Grade/Step	Salary*	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Lead Public Affairs Specialist	14/6	$141,534	1%		$141.53
Predoctoral Fellow	>3 years, 5th year	$47,380	1%		$473.80
Contractor Cost
Travel
Other Cost
Total					$615.33

*the Salary in table above is cited from https://www.training.nih.gov/predoctoral_irta_stipend_levels

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?

We will not attempt to identify respondents. The survey will be emailed to individuals who registered for the Rural Health Day event for 2021, which will be held November 18^th, 2021. When responding, survey respondents will not supply any identifying information, nor will we attempt to collect IP addresses, etc. If identifying information is provided willingly by the respondent in the text box, the entirety of the response will be stored in an Excel spreadsheet of responses.

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

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

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