0990-0379_NationalWomensHealthWk OMB FAST TRACK 4 9 12

Request for Approval under the

“Generic Clearance for the Collection of Routine Customer Feedback”

(OMB Control Number: 0990-0379)

Title of Information Collection

Survey of National Women’s Health Week Partners

Purpose

National Women’s Health Week (NWHW) aims to promote women’s health and empower women to make themselves and their health priorities. In its 12^th year, NWHW marshals the resources and goodwill of businesses, non-profit and community organizations, medical associations, government agencies, and other groups across the country to facilitate and encourage healthful habits and actions. During NWHW 2011, the Office on Women’s Health (OWH) collaborated with 836 entities across the nation to organize 2,058 events. To facilitate these events, OWH provides a rich set of resources to collaborators, such as ideas, guides, templates for event planning, and Spanish language fact sheets.

OWH is seeking clearance for a survey of the organizations that collaborate with OWH on NWHW. The project will answer the following questions:

• How satisfied are partnering organizations with the activity planning resources that OWH provides for NWHW?

• How did partnering organizations hear/learn about NWHW?

• How did partnering organizations promote NWHW, and their events?

• What types of NWHW events did partnering organizations hold across the country?

• What value does NWHW provide to partnering organizations?

• How do partnering organizations rate the brand equity of NWHW?

Based on the analysis of the survey, the project will generate recommendations for making future observances of NWHW more effective and applicable to OWH collaborators.

Description of Respondents

Potential survey respondents form a sub-set of individuals who registered their organizations and an NWHW event on the OWH website during the 2011 NWHW and those who will register for the 2012 NWHW. The sub-set is of those registrants who opted into being contacted for future evaluations during the registration process.

Type of Collection

[ ] 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: Judith Labiner-Wolfe, Office on Women’s Health.

[email protected]

(202) 260-0904

Personally Identifiable Information

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

2. If Yes, will any information that is collected be included in records that are subject to the

Privacy Act of 1974? [ ] Yes [ ] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No

Gifts or Payments

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes []No

Burden Hours

Category of Respondent	Number of Respondents	Participation Time (hours)	Burden (hours)
Individuals	1,000	15/60	250
Totals	1,000	15/60	250

Federal Cost

The estimated annual cost to the Federal government is $75,000.00. This includes the OWH contract with the research firm Impaq to design, implement and analyze the survey results, and OWH staff time to oversee the project.

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.

Potential survey respondents are a subset of the collaborators who registered their NWHW events on the OWH Website during the 2011 NWHW and those who will register for the 2012 NWHW. The registration system gives registrants the option to opt into being contacted for future evaluations. All those registrants who agreed to participate in future evaluations form the universe of survey respondents and will be invited to participate in the survey. The survey is a census of this universe; there will be no sample selection within the universe.

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.

OMB Fast Track Clearance Form Page 6 Survey of National Women’s Health Week Partners