Generic Clearance for Surveys of Customers and other Partners (CC)

Forms and Documents

Document Name	Status
Form 1 Survey of Patients' Perceptions of the Impact of Third Party Billing on Clinical Research Participation Form and Instruction	New
Form 1 Clinical Research Participants Form	New
CC Inpatient Survey.pdf Supplementary Document	2010-11-29
DRIS Patient Perception Survey.pdf Supplementary Document	2010-11-29
Clinical Center part A November 2010 revised.docx Supporting Statement A	2010-11-29

IC Document Collections

IC ID	Document Title	Status
207221	Survey of Patients' Perceptions of the Impact of Third Party Billing on Clinical Research Participation Form and Instruction	New
197342	Clinical Research Participants Form	New

ICR Details

OMB Control No: 0925-0458	ICR Reference No: 201011-0925-007
Status: Historical Active	Previous ICR Reference No: 200708-0925-002
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Generic Clearance for Surveys of Customers and other Partners (CC)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/28/2010
	Date Received in OIRA: 11/30/2010
Terms of Clearance: Approved consistent with previous terms of clearance: This ICR is approved on the understanding that results of these surveys will be primarily for internal agency use only. The following terms of clearance also apply. (1) To the extent that results will be made public, all study limitations will need to be clearly discussed in supporting statements and in public reports. Since NIH does not plan for robust follow-up to minimize non-response, NIH should report the response rates and analyze for potential non-response bias. (2) This generic ICR is approved for the purpose of conducting customer satisfaction surveys of similar scope to the prototype ICs submitted as part of this package. (3) Given that this generic ICR is not intended to be a robust evaluation of program quality but, rather, informal customer satisfaction surveys, NIH shall consider whether it really needs to survey over 58,000 respondents. Prior to submission of individual generic ICs under this umbrella ICR, NIH will conduct a power analysis for each generic IC and describe in the supporting statement how the target sample sizes were determined and why they need to be so large for purposes of a customer satisfaction survey. (4) When providing assurances of confidentiality, NIH will disclose on all materials sent to respondents the statutory authority NIH has to provide assurances of confidentiality. If NIH determines it does not have this statutory authority and has not obtained an equivalent authority (e.g. certificate of confidentiality), NIH will not provide assurances of confidentiality. (5) NIH will adhere to OMB standards regarding race/ethnicity questions on all IC instruments. (6) This generic ICR is approved consistent with NIH agreement to submit individual collections to OMB as they are implemented, along with all necessary supporting statements (to include information about research design and analysis, incentives, burden estimates, approaches to address non-response bias, etc). OMB will aim to review each IC submission within 14 days; however, OMB approval should not be assumed if not explicitly granted, even if 14 days have elapsed since submission.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2013	36 Months From Approved	12/31/2010
Responses	44,935	0	58,335
Time Burden (Hours)	17,352	0	21,884
Cost Burden (Dollars)	0	0	0

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Abstract: The Warren Grant Magnuson Clinical Center will conduct surveys of its customers and other partners to assess perceptions about the quality of care and services provided at the Clinical Center. Data will be used to drive performance improvement.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Customer Satisfaction Surveys
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 57470	09/21/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 73111	11/29/2010
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Clinical Research Participants	1	Patient Survey
Survey of Patients' Perceptions of the Impact of Third Party Billing on Clinical Research Participation	1	Third Party Billing Survey

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	44,935	58,335	0	0	-13,400	0
Annual Time Burden (Hours)	17,352	21,884	0	0	-4,532	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/30/2010

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