Generic Clearance for Surveys of Customers and other Partners (CC)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Third Party Billing Survey	Form and Instruction	Unchanged	Available
Form 1 Patient Survey	Form	Unchanged	Repair queued
NIH-CC Sample Data Collection Instrument for Generic Clearance.pdf	Supplementary Document	Uploaded 2014-02-03	Available
Clinical Center OMB Generic Clearance for Surveys SSB - January 2014.doc	Supporting Statement B	Uploaded 2014-02-03	Available
Clinical Center OMB Generic Clearance for Surveys SSA - January 2014.docx	Supporting Statement A	Uploaded 2014-02-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
207221	Survey of Patients' Perceptions of the Impact of Third Party Billing on Clinical Research Participation	Form and Instruction	Unchanged	Third Party Billing Survey
197342	Clinical Research Participants	Form	Unchanged	Patient Survey

ICR Details

OMB Control No: 0925-0458	ICR Reference No: 201401-0925-006
Status: Historical Active	Previous ICR Reference No: 201011-0925-007
Agency/Subagency: HHS/NIH	Agency Tracking No: 21345
Title: Generic Clearance for Surveys of Customers and other Partners (CC)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/12/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/03/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	36 Months From Approved
Responses	36,915	0	0
Time Burden (Hours)	14,700	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Warren Grant Magnuson Clinical Center will conduct surveys of its customers and other partners to assess perceptions about the quality of care and services provided at the Clinical Center. Data will be used to drive performance improvement.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Customer Satisfaction Surveys
  

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:
	78 FR 66750	11/06/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 3833	01/23/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Clinical Research Participants	1	Patient Survey
Survey of Patients' Perceptions of the Impact of Third Party Billing on Clinical Research Participation	1	Third Party Billing Survey

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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	36,915	0	0	44,935	-8,020	0
Annual Time Burden (Hours)	14,700	0	0	17,352	-2,652	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 has been an ongoing performance improvement program, designed to gather the perceptions of the quality of care and services provided to the Clinical Center's customers and other partners; these surveys should continue to drive service and program changes, as they have in the past. Such voluntary customer survey work is required by EO 12862. This generic clearance expired 12/31/13 and no data have been collected since then pending reinstatement. In this reinstatement request, the Clinical Center plans to bring 4,900 burden hours annually back to the inventory. This adjustment reflects plans to survey fewer visitors, vendors and collaborating enterprises, and therefore the overall annual burden hours have been reduced from the previous clearance of 5,500-6,000.

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Annual Cost to Federal Government: $75,000

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: 02/03/2014

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