NIDDK_1301_05_Generic Clearance Form

SUBMISSION OF INFORMATION COLLECTION

UNDER GENERIC CLEARANCES

DATE OF REQUEST: ___1/15/08___________

SUB AGENCY (I/C): NIH NIDDK National Institute of Diabetes and Digestive and Kidney Diseases

TITLE: _ National Kidney Disease Education Program’s Family Reunion Health Guide and Related Resources Web site User Satisfaction Evaluation Survey

GENERIC CLEARANCE UNDER OMB# ­_0925-0486_ EXP. DATE: 07/31/2010

ABSTRACT:

This Web survey is designed to measure customer satisfaction with NIDDK’s National Kidney Disease Education Program (NKDEP) Family Reunion Web site; URL http://www.nkdep.nih.gov/familyreunion. NKDEP seeks to learn about the experience of individuals using the Family Reunion Health Guide, the centerpiece of the Family Reunion Initiative (FRI). NKDEP seeks to ensure that the piece meets the information and resource needs of users and that the tool is easy to use. More specifically, NKDEP would like to learn how users feel the piece may be improved upon, if at all, and what users consider the best strategies for informing potential users about the Guide and related materials. The information collected will be used internally to improve upon the Guide, if needed, and inform dissemination practices to ensure NKDEP is using efficient and high-impact tactics for informing potential users about the tool. The web based survey contains two tracks: a user track and a partner/promoter track. All survey respondents will start on the user track. They will continue on the user track if they have used the Guide to share information with their families. If respondents have disseminated the Guide to the public but have not used the Guide with their family, they will continue on the partner promoter track. The online survey will be stopped when a total of 100 users’ and 15 promoters’ surveys are completed. The information collected will be used by the NKDEP to improve upon the usefulness and user-friendliness of the Guide on the Family Reunion Web site.

TOTAL ANNUAL BURDEN APPROVED: __________

TOTAL ANNUAL BURDEN APPROVED: 8684.00

BURDEN USED TO DATE: 1921.5

BURDEN THIS REQUEST: 9.6

IS RACE AND ETHNICITY DATA COLLECTED AS REQUIRED?

______YES ____x__NO______N/A

OBLIGATION TO RESPOND:

___x___ VOLUNTARY

______ REQUIRED TO OBTAIN OR RETAIN BENEFITS

______ MANDATORY

HOW WILL THIS SURVEY BE OFFERED?

___x__ WEB SITE

_____ TELEPHONE INTERVIEW

_____ MAIL RESPONSE

_____ IN PERSON INTERVIEW

_____ OTHER: ___________________________________

CONTACT INFORMATION:

NAME: ___Eileen Newman________________________________________

TELEPHONE NUMBER: __301-435-8116__________________________
EMAIL ADDRESS: [email protected]_______________________________