Fast Track Template

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

T ITLE OF INFORMATION COLLECTION: NCCAM Customer Service Data Collection for the NCCAM Clinical Digest e-Newsletter

PURPOSE: The NCCAM Clinical Digest e-newsletter is a fundamental tool for providing health care providers, complementary health practitioners, and others with the latest scientifically based information on complementary health approaches. NCCAM wishes to measure customer satisfaction with the newsletter to better tailor content to the subscribers’ needs. The responses would allow NCCAM to gauge what topics and resources health professionals are most interested in and construct ideal formats.

All subscribers to the NCCAM Clinical Digest page on NCCAM’s Web site will be asked to complete a brief online survey regarding newsletter preferences. Completion will be voluntary with no payment and individual responses will be kept secure to the extent permitted by law. The online survey consists of 9 questions. NCCAM uses the data collected from the survey to help program staff measure the impact of their communication efforts, tailor services to health care providers, and assess the most effective media and messages to reach these audiences.

DESCRIPTION OF RESPONDENTS: Respondents are health care professionals, consumers, or other individuals who have subscribed to the NCCAM Clinical Digest newsletter.

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:__Shawn K. Stout______________________________________________

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

3. If Applicable, has a System or Records Notice 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 (average burden hours per response)	Burden
Individuals or households	570	5/60	48

FEDERAL COST: The estimated annual cost to the Federal government is $2,000.

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?

Respondent Universe and Sampling Methods

The population for the online newsletter survey consists of subscribers to the NCCAM Clinical Digest e-newsletter, a monthly Web publication designed for health professionals. The current number of subscribers to the e-newsletter is 19,082. NCCAM is interested in continuing to ascertain how satisfied subscribers are with the information provided.

Each subscriber will be asked to complete the survey. Assuming a gross response rate of 3 percent based on survey results to date, the actual number of subscribers participating in the survey is estimated to be 570.

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

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

Attachments:

Appendix A: Survey Instrument

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