fast track template NEI generic clearance 05-01-12

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0925-0648)

TITLE OF INFORMATION COLLECTION:

Comment Card for Soliciting Feedback on NEI Public Inquiry Response

PURPOSE:

The National Eye Institute will collect feedback and valuable information on NEI customer service, health information and publications via a comment card that will be included in mail packages sent in response to public inquiries. The collection will end at 90 days or when the supply of comment cards is exhausted, whichever comes first.

DESCRIPTION OF RESPONDENTS:

The respondents completing the comment card will be inquirers that contact the National Eye Institute by email and customers that place publication orders through the National Eye Institute online catalog.

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: Kym Collins-Lee, Public Liaison Officer, National Eye Institute

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 [ ] No [X] N/A

3. If applicable, has a System or Records Notice been published? [ ] Yes [ ] No [X] N/A

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	4,200	5 minutes	350 Hours
Totals	4,200		350 hours

FEDERAL COST: The estimated annual cost to the Federal government is $6,402.

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 [x] 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?

A comment card will be included in all mail packages used to respond to public inquiries during the survey period.

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

[x] Mail

[ ] Other, Explain

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

2