NIDA Fast Track(OMB cntrl # 0925-0655) - Fast Track Template

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0925-0655)

TITLE OF INFORMATION COLLECTION: Information Collection on the NIDA for Teens Web Site on Usefulness and Knowledge to be Learned

PURPOSE: To obtain information to describe customer satisfaction with the NIDA for Teens website, from high school students and teachers. The survey results will inform us on what revisions to make to the dissemination site to improve the uptake of its information, and to know if it is worth continuing the resources spent on it.

(2-3 sentences)

DESCRIPTION OF RESPONDENTS: 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.

Teachers and students used as respondents in the study will be from the schools in NIDA’s database of high schools that participated in the NIDA Chat Day event in 2010-2012. These schools will be solicited for their participation. Respondents may have seen the site before this time, since it is in the public domain.

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: (whatever specifics you need to include)

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.

Name and IC: Genevieve deAlmeida, National Institute on Drug Abuse

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? [x] Yes, to the schools. [] No

BURDEN HOURS

Category(s) of Respondent- Individuals and Households	No. of Respondents	Participation Time (in hrs.)	Total Burden Hrs.
High School Students	300	30/60	150
Teachers - survey	60	30/60	30
Teachers – survey instructions	60	10/60	10
Students – survey assignment instructions	300	1/60	5

FEDERAL COST: The estimated annual cost to the Federal government is $115,974.0, made up of $112,374.0 Contract cost plus $3,600 NIDA Project Officer and Evaluator staff time

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?

1. NIDA has a list of the nation’s high schools that participated in its Chat Day event. This is an annual event. Schools from NIDA’s Chat Day event participation list will be solicited for participation- several of them around the country have already offered to participate. They will be informed that students and teacher volunteers are needed; that the survey will be web-based and will be accessible from school computers or students’ and teachers’ home computers; that students can take the survey in school or as a homework assignment.

2. Consent forms and assent forms will be sent to participating schools for their volunteering students, and consent forms will be sent to the schools for volunteering teachers. The schools will be asked to be responsible for the distribution and collection of signed consent and assent forms of students, and consent forms for teachers. The schools will also be responsible for informing the Contractor of the number of study IDs needed for student participants per class, and the number of study IDs for teacher participants, that will be needed for their login to the surveys.

3. Study IDs for the participants will be sent to the schools by the Contractor.

4. A sample of 300 students, and a sample of 60 teachers, is planned for the study. All students with parental consent to participate will have the option to assent to participate, and will be provided with access to the survey site. All teachers who consent to participation will be provided with access to the survey site. The first set of 300 completed student surveys will be used in the study. The first set of 60 completed teacher surveys will be used in the study.

5. Assuming 20 students from a school will volunteer for participation, a set of 15 consenting schools will be needed. Assuming 4 teachers from each school will volunteer for participation, a set of 15 consenting schools will be needed for the study. However it may be necessary to tap more schools in order to get the desired numbers of participants, and 20 schools are planned for the study. In appreciation an Apps card to enable purchase of an application useful to students’ learning or to teachers’ teaching, will be given to each participating school. The Apps card will be limited to $20.

6. It is anticipated that more than 20 schools across the country will volunteer participation. If so, schools will be selected to represent as many different geographic areas of the country as possible, in order to get participants from metropolitan, urban, and rural areas and areas with different racial and ethnic population subgroups.

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 Attachments

IRB Letter of Approval

Teacher Survey Screenshot

Student Survey Screenshot

Teacher Survey

Student Survey

Consent Form Teachers

Consent Form Parents

Letter to Principals

Principals Consent Form

Statement of Study Specifics

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