Supporting Statement

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

T ITLE OF INFORMATION COLLECTION:

PURPOSE:

The Comparative Effectiveness Research Inventory is a resource of value to researchers, health care providers, policy makers and patients and consumers, providing relevant information on the products of the nation’s investment in comparative effectiveness research through a flexible, user-friendly interface. The purpose of this form (Appendix A) is to provide end users with a mechanism for submitting feedback on the Inventory’s functionality and contents. This collection of customer feedback will obtain information of value for planning and implementing modifications and enhancements to the Inventory in the future, to increase its value over time. The form does not collect PII. The form provides a drop down for users to note their “Sector”: Not Applicable; Government-research; Government-general; Academic; Other nonprofit; Other researcher; Other. Selection of a sector is not required in order to submit feedback.

DESCRIPTION OF RESPONDENTS:

Respondents will be end users of the Comparative Effectiveness Inventory, including researchers, health care providers, policy makers, patients and consumers who are using the Inventory to obtain current and comprehensive information on comparative effectiveness research.

TYPE OF COLLECTION: (Check one)

[ x ] Customer Comment Card/Complaint Form [ ] 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: Pierre Yong

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 [X] 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	500	15 min	125 hrs
Totals

FEDERAL COST: The estimated annual cost to the Federal government is $12,500________

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 [ ] 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?

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [ ] No

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

Attachments: Appendix A—customer comment card

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