SS_Attachment_1_-__Example_of_NLM_Generic_Clearance_Request

SUBMISSION OF INFORMATION COLLECTION
UNDER GENERIC CLEARANCES
DATE OF REQUEST: 2/16/2010
SUB AGENCY (I/C): National Library of Medicine
TITLE: NLM CervigramFinder Physician Survey
GENERIC CLEARANCE UNDER OMB# 0925-0476

EXP. DATE: 06/30/2012

ABSTRACT:

We request clearance for an in-person survey of physicians attending the 2010 biennial meeting of the American
Society for Colposcopy and Cervical Pathology (ASCCP) in Las Vegas, Nevada from March 24 – 27, 2010. Paper
copies of this survey will be placed in information bags provided to every registered attendee at the conference.
Attendees will be asked to voluntarily complete the survey and return it to a designated booth manned by staff from
the National Library of Medicine in the exhibit hall. No identifying or demographic information about the users will
be collected.
The survey results will help determine the interest of specialized physicians in accessing the NLM CervigramFinder
and Boundary Marking Tool, as well as determine the points of interest most relevant to work conducted by these
specialists.
TOTAL ANNUAL BURDEN APPROVED: 3,600 hours
BURDEN USED TO DATE: 0000
BURDEN THIS REQUEST: 33.33 hours
IS RACE AND ETHNICITY DATA COLLECTED AS REQUIRED?
______YES __X__NO______N/A
OBLIGATION TO RESPOND:
X

VOLUNTARY

______ REQUIRED TO OBTAIN OR RETAIN BENEFITS
______ MANDATORY
HOW WILL THIS SURVEY BE OFFERED?
_____ WEB SITE
_____ TELEPHONE INTERVIEW
_____ MAIL RESPONSE
X

IN PERSON INTERVIEW

_____ OTHER: ___________________________________
CONTACT INFORMATION:
NAME: Sarah Ward
TELEPHONE NUMBER: 301-407-7722
EMAIL ADDRESS: [email protected]