#5 Fast Track Request DCP

Request for Approval under the

“Generic Clearance for the Collection of Routine Customer Feedback” (NCI)

(OMB Control Number: 0925-0642-05, Expiration Date 9/30/2014)

T ITLE OF INFORMATION COLLECTION:

DCP Nutrition Frontiers Newsletter Survey

PURPOSE:

The Nutrition Frontiers is a quarterly electronic newsletter from the Nutritional Science Research Group (NSRG), Division of Cancer Prevention, NCI, NIH. The primary purpose of the newsletter is to educate readers on emerging basic science and clinical studies generated by those in the nutrition and cancer prevention community, specifically targeting NSRG-supported research. The first issue was electronically distributed in the winter of 2010. As the current technology does not allow for email tracking, it is unclear if subscribers are reading the newsletter, and if so, if they are finding it useful and relevant. We have had some positive feedback from readers through individual emails, however, we would like a more comprehensive evaluation of the newsletter. The purpose of the survey is to gain insight on readership, relevance, interest level, and overall feedback of the Nutrition Frontiers newsletter.

DESCRIPTION OF RESPONDENTS:

Subscribers of the Nutrition Frontiers listserv, which is comprised of scientists, researchers, and clinicians interested in nutrition and cancer prevention.

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: Elaine Trujillo

To assist review, please provide answers to the following question:

Personally Identifiable Information:

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

2. If Yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [X] Yes [ ] No

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

Although we are not collecting names, we would be sending the survey to subscribers of a listserv, which contains email addresses and sometimes subscribers’ names.

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	1000	5 minutes (0.08)	83
Totals	1000	5 minutes	83

Total Burden Hours used for IC’s to date: 115

Total Burden Hours Approved for IC’s under 0925-0642: 8750

Total Burden Hours currently requested: 83

FEDERAL COST: The estimated annual cost to the Federal government is $1000.00.

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?

NutritionFrontiers NIH Listserv, which is comprised of approximately 1200 subscribers.

The survey would be distributed to the entire list, realizing that only a percentage will respond.

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, Explain

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

List of instruments, instructions, and scripts submitted with this request:

Attachment 1: Email Invitation, Survey/Questionnaire, and Screenshots

5