Fast Track Template

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

TITLE OF INFORMATION COLLECTION: SeroNet Investigators Meeting 2023 Participant Feedback Survey (NCI)

PURPOSE: The SeroNet Investigators Meeting is an annual conference event for the members of the Serological Sciences Network (SeroNet). The event aims to showcase the ongoing research and development studies in the areas of SARS-CoV-2 among the members of the SeroNet. The feedback survey will be used to make improvements for next year’s Investigators Meeting. The information will be pooled to assess components of the meeting for meeting planning.

DESCRIPTION OF RESPONDENTS: The survey will be sent only to the March 2023 SeroNet Investigators Meeting participants. No PII will be collected. The responses will be collected in aggregate.

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: ______________________ ______

FREQUENCY OF REPORTING: (Check one)

[ X ] Once [ ] Quarterly

[ ] Monthly [ ] On Occasion

[ ] Annually [ ] Other ___________________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is a low burden for respondents and a 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 to inform effective policy decisions substantially.

6. The collection is targeted to soliciting opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: Samantha Finstad

Please answer the following question to assist with the review: If you collect names and emails, check yes for PII.

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 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

Amount: _________

The explanation for incentive: (include the number of visits, etc.)

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	400	1	5/60	33
Totals		400		33

Category of Respondent	Total Burden Hours	Wage Rate*	Total Burden Cost
Individuals	33	$49.44	$1,631.52
Total			$1,631.52

*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/2021/May/oes_nat.htm#19-1040.

FEDERAL COST: The estimated annual cost to the Federal government is $705.20

Staff	Grade/Step	Salary**	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Program Manager	15/10	176,300	.004		$705.20
Contractor Cost					$0
Travel					$0
Other Cost					$0
Total					$705.20

**The salary in the table above is cited from: https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/22Tables/html/DCB.aspx

If you are conducting a focus group or 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

2. If yes, please describe both below (or attach the sampling plan). If the answer is no, please tell how you plan to identify your potential respondents and how you will select them.

An email containing a link to an online survey will be sent to the participants of the March 2023 SeroNet Investigators Meeting.

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

[ ] Survey Form

[ ] Chart Abstraction

[ ] Other, Explain

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

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

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