Research Activities Newsletter Feedback OMB Submission Form 10-21-2011

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0935-0179)

T ITLE OF INFORMATION COLLECTION: Customer Satisfaction with AHRQ’s Research Activities Newsletter

PURPOSE: To obtain feedback on how readers of AHRQ’s Research Activities Newsletter like the new features (cover story and director’s column), which other features they would like to see, and to find out how they use the information. We would also like to better identify the type of professionals who read Research Activities: researchers, clinicians, policymakers, health care administrators, etc. and how they use the information in the newsletter, for example, for teaching, in discussions with colleagues, for ideas on furthering research, etc.

DESCRIPTION OF RESPONDENTS:

All persons that have signed up through AHRQ’s website to receive the newsletter (31,763) will be sent an email invitation to participate in the survey. These persons are typically clinicians, researchers, healthcare administrators, and policymakers with an interest in health care research. An announcement of the online survey will also be put in an issue of the printed newsletters with a link to the online survey so that all of the print subscribers (28,356) can take the survey. Print subscribers are similar to the online subscribers.

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:_Gail Makulowich___________________________________

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

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Individuals or Households	3,000	1 minute	50 hours
Totals	3,000	1 minute	50 hours

FEDERAL COST: The estimated annual cost to the Federal government is _$650___________

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?

AHRQ has a mailing list of the print subscribers and email addresses of the electronic subscribers. We will send out an email about the survey to our electronic subscribers along with reminder emails. We will include an announcement of the online survey with a link to it in newsletters that go to our mailing list of print subscribers.

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, Will interviewers or facilitators be used? [ ] Yes [ x] No

List of Attachments:

Attachment A – Research Activities Newsletter Questionnaire