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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 CDE SurveyMonkey Survey	Form and Instruction	New	Available
Form 1 2015 BRAIN PI screen shot	Form and Instruction	New	Available
Form 1 ASP Survey Screenshot	Form and Instruction	New	Available
Form 1 NINDS HEALTHY BRAIN FOCUS GROUP SCREENER	Form and Instruction	New	Available
Supporting Statement B NINDS Fast Track PRA.docx	Supporting Statement B	Uploaded 2013-07-24	Available
Fast-Track Generic_Clearance_Submission_Template1 (2)[1].doc	Supplementary Document	Uploaded 2013-07-24	Available
Supporting Statement A NINDS Fast Track PRA.doc	Supporting Statement A	Uploaded 2013-07-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
221034	NINDS Common Data Elements (CDE) Survey	Form and Instruction	New	CDE SurveyMonkey Survey
219417	2015 Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Principle Investigators' (Pi) Meeting Conference Survey	Form and Instruction	New	2015 BRAIN PI screen shot
213576	Survey of past participants of the National Institute of Neurological Disorders and Stroke (NINDS) Anticonvulsant Screening Program (ASP)	Form and Instruction	New	ASP Survey Screenshot
213108	Healthy Brain Focus Group	Form and Instruction	New	NINDS HEALTHY BRAIN FOCUS GROUP SCREENER
213108	Healthy Brain Focus Group	Instruction	New

ICR Details

OMB Control No: 0925-0678	ICR Reference No: 201307-0925-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No: 20140
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NINDS)
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 without change	Conclusion Date: 08/29/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/30/2013
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	08/31/2016	36 Months From Approved
Responses	44,100	0	0
Time Burden (Hours)	17,250	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable the National Institute of Neurological Disorders and Stroke 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 the Agency's programs. This feedback will provide insights into customer or stakeholder perceptions, experiences and expectations, provide an early warning of issues with service, or focus attention on areas where communication, training or changes in operations might improve delivery of products or services. These collections will allow for ongoing, collaborative and actionable communications between the Agency and its customers and stakeholders. It will also allow feedback to contribute directly to the improvement of program management.

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Authorizing Statute(s): None

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 80542	12/22/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 44133	07/23/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
2015 Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Principle Investigators' (Pi) Meeting Conference Survey	1	2015 BRAIN PI screen shot
Healthy Brain Focus Group	1	NINDS HEALTHY BRAIN FOCUS GROUP SCREENER
NINDS Common Data Elements (CDE) Survey	1	CDE SurveyMonkey Survey
Survey of past participants of the National Institute of Neurological Disorders and Stroke (NINDS) Anticonvulsant Screening Program (ASP)	1	ASP Survey Screenshot

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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	44,100	0	0	44,100	0	0
Annual Time Burden (Hours)	17,250	0	0	17,250	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 request.

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Annual Cost to Federal Government: $195,000

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: 07/30/2013

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