fast track for NEHEP Pre-Post Summit surveys

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

TITLE OF INFORMATION COLLECTION: NEHEP Partnership Summit Surveys (NEI)

PURPOSE: The National Eye Institute (NEI) is partnering with CommunicateHealth (CH) to develop and distribute voluntary pre- and post-summit surveys for the National Eye Health Education Program (NEHEP) Partnership Summit to summit registrants to learn more about their ideas and experiences. Specifically:

• The pre-survey will collect feedback on their ideas and interests to inform how attendees are sorted into discussion circles so that they have productive and engaging conversations during the summit

• The post-survey will collect feedback about summit topics and activities to inform planning for future summits

DESCRIPTION OF RESPONDENTS: This study will consist of up to 100 participants who register for the summit. Registrants will be professionals working at or affiliated with NEHEP partner organizations or professionals who act as NEHEP consultants.

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 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: Devina Fan_________________________________________

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

Personally Identifiable Information:

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

The only PII that will be collected are names, emails, and organization name. NOTE: Email addresses will only be used for contacting participants.

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

3. If Applicable, has a System or Records Notice been published? [X] 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	100	2	10/60	33
Totals		200		33

Category of Respondent	Total Burden Hours	Hourly Wage Rate*	Total Burden Cost
Health Education Specialist	33	$31.22	$1,030.26
Totals			$1,030.26

https://www.bls.gov/oes/current/oes_47900.htm#00-0000 (Occupation Title: All Occupations)

FEDERAL COST: The estimated annual cost to the Federal government is $9,986.70.

Staff	Grade/Step	Salary*	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Public Health Advisor	12/2	$97,339	0.5%		$486.70
Contractor Cost		$110/hr			$9,500
Travel
Other Cost
Total					$9,986.70

*the Salary in table above is cited from https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2023/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? [ ] Yes [X] 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?

Recruitment Process:

CH will invite up to 100 professionals to the NEHEP Partnership Summit using an existing list of emails. CH will then distribute pre- and post-surveys to all professionals who register for and/or attend the event.

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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