Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NICHD)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Online customer satisfaction survey screen shots	Form and Instruction	New	Available
Form 1 DSDR Screenshots	Form and Instruction	New	Available
Form 7 Recruitment Screener PPD Moms	Form and Instruction	New	Available
Form 5 Moderators Guide PPD Moms	Form and Instruction	New	Available
Form 4 Moderators Guide general mom	Form and Instruction	New	Available
Form 3 Moderator Guide Fathers	Form and Instruction	New	Available
Form 2 Recruitment Screener Mom In-person Focus Group	Form	New	Available
Form 1 Recruitment Screener Fathers	Form	New	Available
Form 6 Recruitment Screener Mom telephone focus group	Form and Instruction	New	Available
Form 1 Nurse CE Program Survey	Form and Instruction	New	Available
Form 4 Moderator's Guide for Pregnant Women	Form and Instruction	New	Available
Form 3 Recruitment Screener for Pregnant Women	Form and Instruction	New	Available
Form 2 Moderator's Guide for Breastfeeding Women	Form and Instruction	New	Available
Form 1 Recruitment Screener for Breastfeeding Women	Form and Instruction	New	Available
Form 3 Pregnant Women	Form and Instruction	New	Available
Form 1 Screener	Form and Instruction	New	Available
Form 2 Focus Group fathers	Form and Instruction	New	Available
Form 1 Screener	Form and Instruction	New	Available
Form 2 Moderators Guide	Form and Instruction	New	Available
Form 2 Moderators Guide	Form and Instruction	New	Available
Form 1 Screener	Form and Instruction	New	Available
Form 2 Moderators Guide	Form and Instruction	New	Available
Form 1 Screener	Form and Instruction	New	Available
Generic_Clearance_Submission_Template[1].doc	Supplementary Document	Uploaded 2011-10-24	Available
generic_qualitative_feedback_NICHD_ Part B only.docx	Supporting Statement B	Uploaded 2011-10-18	Available
SSA generic_qualitative_feedback_NICHD_8-10-11[1].docx	Supporting Statement A	Uploaded 2011-10-18	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
212869	Opportunities for Extramural Collaborations at the NIH Clinical Center (U01) Customer Satisfaction Survey	Form and Instruction	New	Online customer satisfaction survey screen shots
211191	Data Sharing for Demographic Research (DSDR) Customer Satisfaction Survey	Form and Instruction	New	DSDR Screenshots
209998	NICHD Postpartum Depression (PPD) Focus Groups	Form and Instruction	New	Recruitment Screener PPD Moms
209998	NICHD Postpartum Depression (PPD) Focus Groups	Form and Instruction	New	Moderators Guide PPD Moms
209998	NICHD Postpartum Depression (PPD) Focus Groups	Form and Instruction	New	Moderators Guide general mom
209998	NICHD Postpartum Depression (PPD) Focus Groups	Form and Instruction	New	Moderator Guide Fathers
209998	NICHD Postpartum Depression (PPD) Focus Groups	Form	New	Recruitment Screener Mom In-person Focus Group
209998	NICHD Postpartum Depression (PPD) Focus Groups	Form	New	Recruitment Screener Fathers
209998	NICHD Postpartum Depression (PPD) Focus Groups	Form and Instruction	New	Recruitment Screener Mom telephone focus group
209640	Nurses' Continuing Education Program on Sudden Infant Death Syndrome (SIDS)--Customer Satisfaction Survey	Form and Instruction	New	Nurse CE Program Survey
208131	Safe to Sleep Campaign Focus Groups with the Breastfeeding/Lactation Support Community	Form and Instruction	New	Moderator's Guide for Pregnant Women
208131	Safe to Sleep Campaign Focus Groups with the Breastfeeding/Lactation Support Community	Form and Instruction	New	Recruitment Screener for Pregnant Women
208131	Safe to Sleep Campaign Focus Groups with the Breastfeeding/Lactation Support Community	Form and Instruction	New	Moderator's Guide for Breastfeeding Women
208131	Safe to Sleep Campaign Focus Groups with the Breastfeeding/Lactation Support Community	Form and Instruction	New	Recruitment Screener for Breastfeeding Women
201950	Non-Medically Indicated Induction Prior to 39 Weeks of Gestation Focus Groups	Form and Instruction	New	Pregnant Women
201950	Non-Medically Indicated Induction Prior to 39 Weeks of Gestation Focus Groups	Form and Instruction	New	Screener
201950	Non-Medically Indicated Induction Prior to 39 Weeks of Gestation Focus Groups	Form and Instruction	New	Focus Group fathers
201164	Back to Sleep Brand Identity Testing	Form and Instruction	New	Screener
201164	Back to Sleep Brand Identity Testing	Form and Instruction	New	Moderators Guide
200993	Back to Sleep Brand Identity Testing	Form and Instruction	New	Moderators Guide
200993	Back to Sleep Brand Identity Testing	Form and Instruction	New	Screener
200805	Back to Sleep Brand Identity Testing	Form and Instruction	New	Moderators Guide
200805	Back to Sleep Brand Identity Testing	Form and Instruction	New	Screener

ICR Details

OMB Control No: 0925-0643	ICR Reference No: 201110-0925-003
Status: Historical Active	Previous ICR Reference No: 201110-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NICHD)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/31/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/24/2011
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.”

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2014	36 Months From Approved
Responses	45,600	0	0
Time Burden (Hours)	14,850	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (NIH) to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with NICHD's programs.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Customer Satisfaction
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 245	12/22/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 55398	09/07/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 9

table that charts list of burden

IC Title	Form No.	Form Name
Back to Sleep Brand Identity Testing	2, 1	Moderators Guide ,   Screener
Back to Sleep Brand Identity Testing	2, 1	Screener ,   Moderators Guide
Back to Sleep Brand Identity Testing	1, 2	Screener ,   Moderators Guide
Data Sharing for Demographic Research (DSDR) Customer Satisfaction Survey	1	DSDR Screenshots
NICHD Postpartum Depression (PPD) Focus Groups	1, 2, 3, 4, 5, 6, 7	Recruitment Screener Fathers ,   Recruitment Screener Mom In-person Focus Group ,   Moderator Guide Fathers ,   Moderators Guide general mom ,   Moderators Guide PPD Moms ,   Recruitment Screener Mom telephone focus group ,   Recruitment Screener PPD Moms
Non-Medically Indicated Induction Prior to 39 Weeks of Gestation Focus Groups	2, 1, 3	Focus Group fathers ,   Screener ,   Pregnant Women
Nurses' Continuing Education Program on Sudden Infant Death Syndrome (SIDS)--Customer Satisfaction Survey	1	Nurse CE Program Survey
Opportunities for Extramural Collaborations at the NIH Clinical Center (U01) Customer Satisfaction Survey	1	Online customer satisfaction survey screen shots
Safe to Sleep Campaign Focus Groups with the Breastfeeding/Lactation Support Community	1, 2, 3, 4	Recruitment Screener for Breastfeeding Women ,   Moderator's Guide for Breastfeeding Women ,   Recruitment Screener for Pregnant Women ,   Moderator's Guide for Pregnant Women

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	45,600	0	0	45,600	0	0
Annual Time Burden (Hours)	14,850	0	0	14,850	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new ICR.

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Annual Cost to Federal Government: $446,545

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/24/2011

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