VA Office of Public Health Newsletter Survey Submission

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 2900-0770)

T ITLE OF INFORMATION COLLECTION:

Office of Public Health Environmental Exposure Newsletter Survey

PURPOSE:

The VA Office of Public Health (OPH) produces and mails a variety of newsletters focused on environmental exposures associated with deployment as one of several services to Veterans. This one-time survey is designed to improve the service delivery of these newsletters by collecting data on the usefulness of the information provided in the newsletters, preferred format for receiving the newsletters, and other sources Veterans use to obtain information on exposures. Given changing technology (social media, internet, email), this survey is essential in order to determine the appropriate format to provide this critical information to best serve the needs of Veterans and best use government resources.

DESCRIPTION OF RESPONDENTS:

Respondents will consist of Veterans who served in Vietnam, the Gulf War, OEF/OIF, or were exposed to ionizing radiation and are currently receiving one of four of the Office of Public Health’s newsletters (Agent Orange Review; Gulf War Veterans’ Illnesses, Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Hazardous Exposures, and/or Ionizing Radiation Review. These Veterans consist of men and women, ages 18 and older, who have requested to receive one of the aforementioned newsletters.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [X] Other: Newsletter Usefulness/Format Survey

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: Steven Sloane

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, 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 [X ] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Individuals or Households	10,000	5 minutes	833.33
Totals			833.33

FEDERAL COST: The estimated annual cost to the Federal government is _$50,000___

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? [X] 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?

The survey will be mailed as an enclosure with a sample of OPH’s newsletters (Agent Orange Review; Gulf War Veterans’ Illnesses, Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). Currently there are 1.5 million Veterans who receive the OEF/OIF newsletter; 350,000 who receive the Agent Orange Review; 350,000 who receive the Gulf War Illnesses newsletter; and, 60,000 who receive the Ionizing Radiation review. Veterans will be selected randomly without replacement from each newsletter’s mailing list (4 strata). Based on previous studies of Veterans, we anticipate an overall response rate of 25%. The table below shows the number of Veterans on each mailing list, the number which will be sampled, and the anticipated number of respondents.

		OEF/OIF	Gulf War	Agent Orange	Ionizing Radiation	Total
Veterans Receiving Newsletter	N	1,500,000	350,000	350,000	60,000	2,260,000
	%	66.37%	15.49%	15.49%	2.65%
Survey Sample	N	26,548	6,196	6,196	1,060	240,000
Survey Respondents (25% Response Rate)	N	6,637	1,549	1,549	265	10,000

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

[X] Mail

[ ] Other, Explain

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

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

Instructions for completing Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”

TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the subject of the request. (e.g. Comment card for soliciting feedback on xxxx)

PURPOSE: Provide a brief description of the purpose of this collection and how it will be used. If this is part of a larger study or effort, please include this in your explanation.

DESCRIPTION OF RESPONDENTS: Provide a brief description of the targeted group or groups for this collection of information. These groups must have experience with the program.

TYPE OF COLLECTION: Check one box. If you are requesting approval of other instruments under the generic, you must complete a form for each instrument.

CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.

Personally Identifiable Information: Provide answers to the questions. Note: Agencies should only collect PII to the extent necessary, and they should only retain PII for the period of time that is necessary to achieve a specific objective.

Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.

BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households;(2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be selected per row.

No. of Respondents: Provide an estimate of the Number of respondents.

Participation Time: Provide an estimate of the amount of time required for a respondent to participate (e.g. fill out a survey or participate in a focus group)

Burden: Provide the Annual burden hours: Multiply the Number of responses and the participation time and divide by 60.

FEDERAL COST: Provide an estimate of the annual cost to the Federal government.

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. Please provide a description of how you plan to identify your potential group of respondents and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.

Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.

Submit all instruments, instructions, and scripts are submitted with the request.

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