Request for Generic Clearance to Conduct Voluntary Customer/Partner Surveys(NLM)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 4 Health Inventory Instrument	Form and Instruction	New	Available
Form 3 General Inventory Instrument	Form and Instruction	New	Available
Form 2 Essay Completion Instrument	Form and Instruction	New	Available
Form 1 Instruction rating Instrument	Form and Instruction	New	Available
Form 1 Focus Group	Form and Instruction	Unchanged	Available
Form 1 WHR Consumer Focus Group Survey	Form and Instruction	Unchanged	Available
Form 1 Survey for MICAD Users screenshots	Form and Instruction	Unchanged	Available
Supporting_Statement_A_NLM Generic_Rev Sept 2014.docx	Supplementary Document	Uploaded 2014-09-25	Available
OMB Change Request Memo_NLM Generic Clearance_ Sept 2014.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2014-09-25	Available
SS_Attachment_2_-_Example_of_NLM_Survey_Instrument.pdf	Supplementary Document	Uploaded 2012-06-07	Available
SS_Attachment_1_-__Example_of_NLM_Generic_Clearance_Request.pdf	Supplementary Document	Uploaded 2012-06-07	Available
Supporting_Statement_A_NLM_Generic_ICR_6-5-2012.docx	Supporting Statement A	Uploaded 2012-06-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213754	NLM Distance Learning Mentoring Program Study	Form and Instruction	New	Health Inventory Instrument
213754	NLM Distance Learning Mentoring Program Study	Form and Instruction	New	General Inventory Instrument
213754	NLM Distance Learning Mentoring Program Study	Form and Instruction	New	Essay Completion Instrument
213754	NLM Distance Learning Mentoring Program Study	Form and Instruction	New	Instruction rating Instrument
204984	WHR Professionals Focus Group Survey	Form and Instruction	Unchanged	Focus Group
204405	WHR Consumer Focus Group Survey	Form and Instruction	Unchanged	WHR Consumer Focus Group Survey
203727	User Satisfaction Surevy for MICAD Users	Form and Instruction	Unchanged	Survey for MICAD Users screenshots

ICR Details

OMB Control No: 0925-0476	ICR Reference No: 201409-0925-005
Status: Historical Active	Previous ICR Reference No: 201206-0925-003
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Request for Generic Clearance to Conduct Voluntary Customer/Partner Surveys(NLM)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/04/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/29/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2015	07/31/2015	07/31/2015
Responses	15,000	0	15,000
Time Burden (Hours)	3,250	0	3,250
Cost Burden (Dollars)	0	0	0

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Abstract: NLM will collect and use information gathered through customer and/or partner surveys to identify strengths and weaknesses in current service provisions and to make improvements that are practical and feasible.

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Authorizing Statute(s): US Code: 42 USC 286 Name of Law: Public Health Services 42 C.F.R. PART 4--National Library of Medicine
  

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:
	77 FR 19673	04/02/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 34391	06/11/2012
Did the Agency receive public comments on this ICR? Yes

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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
NLM Distance Learning Mentoring Program Study	2, 3, 4, 1	Instruction rating Instrument ,   Essay Completion Instrument ,   General Inventory Instrument ,   Health Inventory Instrument
User Satisfaction Surevy for MICAD Users	1	Survey for MICAD Users screenshots
WHR Consumer Focus Group Survey	1	WHR Consumer Focus Group Survey
WHR Professionals Focus Group Survey	1	Focus Group

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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	15,000	15,000	0	0	0	0
Annual Time Burden (Hours)	3,250	3,250	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: A reduction of 1,350 burden hours is being requested to adjust for a previous overestimation in the number of responses.

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Annual Cost to Federal Government: $36,000

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 09/29/2014

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