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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 DS Rodent Survey	Form	New	Available
Form 1 PregSourceBeta Test Survey	Form	New	Available
Form 1 Customer Satisfaction Interview protocol	Form and Instruction	New	Available
Form 1 Substudy NICHD Nurse CEP	Form and Instruction	New	Available
Form 1 Customer Satisfavtion Survey NICHd Nurse CEP	Form and Instruction	New	Available
Form 3 PI Survey	Form and Instruction	New	Available
Form 2 Mentors Survey	Form and Instruction	New	Available
Form 1 Scholars Survey	Form and Instruction	New	Available
Form 1 MRRIN Pilot Project Survey	Form and Instruction	New	Available
Form 1 MSY Teen Leaders Nonprofit Partner Final Survey	Form and Instruction	New	Available
Form 1 MSY Teen Leaders_Midpoint Survey	Form and Instruction	New	Available
Form 1 MSY Teen Leaders Final Survey	Form and Instruction	New	Available
Form 1 MSY Teen Leaders Advisor Final Survey	Form and Instruction	New	Available
Form 1 MSY Teen Leaders Advisor Final Survey	Form and Instruction	New	Available
Form 1 High-risk States Outreach Program Customer Satisfaction Survey	Form and Instruction	New	Available
Form 5 HNB_Focus Group Guide MOTHERS	Form and Instruction	New	Available
Form 4 HNB_Focus Group Guide FATHERS	Form and Instruction	New	Available
Form 3 HNB_Focus Group Guide ELDERS	Form and Instruction	New	Available
Form 2 HNB_Focus Group Guide HEALTH PROVIDERS	Form and Instruction	New	Available
Form 1 HNB_Focus Group Guide GENERAL PROVIDERS	Form and Instruction	New	Available
Form 5 Focus Group Guide MOTHERS	Form and Instruction	New	Available
Form 4 Focus Group Guide FATHERS	Form and Instruction	New	Available
Form 3 Focus Group Guide ELDERS	Form and Instruction	New	Available
Form 2 Focus Group Guide HEALTH PROVIDERS	Form and Instruction	New	Repair queued
Form 1 Focus Group Guide GENERAL PROVIDERS	Form and Instruction	New	Available
Attachment 2_0925-0643_List of Sub-Study Approvals.docx	Supplementary Document	Uploaded 2014-10-09	Repair queued
SSB_0925-0643_NICHD Fast Track Extension.docx	Supporting Statement B	Uploaded 2014-10-09	Available
SSA_0925-0643_NICHD Fast Track Extension.doc	Supporting Statement A	Uploaded 2014-10-09	Available
Generic_Clearance_Submission_Template[1].doc	Supplementary Document	Uploaded 2011-10-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
227143	Survey of Researchers Studying Rodent Models for Down Syndrome	Form	New	DS Rodent Survey
224334	Beta Test of PregSource™ Crowd-Sourcing to Understand Pregnancy	Form	New	PregSourceBeta Test Survey
221808	Opportunities for Extramural Collaborations at the NIH Clinical Center (Uo1) Cutomer Satisfaction Interviews	Form and Instruction	New	Customer Satisfaction Interview protocol
221148	NICHD Customer Satisfaction Survey on Continuing Education (CE) Activity on Risk Reduction for Sudden Infant Death Syndrom (SIDS) and Other Sleep-Related Causes of Infant Death: Curriculum for Nurses	Form and Instruction	New	Substudy NICHD Nurse CEP
219250	Nurses' Continuing Education Program on Sudden Infant Death Syndrome (SIDS)	Form and Instruction	New	Customer Satisfavtion Survey NICHd Nurse CEP
217155	BIRCWH Principal Investigator, Mentor, and Scholar Satisfaction Surveys	Form and Instruction	New	PI Survey
217155	BIRCWH Principal Investigator, Mentor, and Scholar Satisfaction Surveys	Form and Instruction	New	Mentors Survey
217155	BIRCWH Principal Investigator, Mentor, and Scholar Satisfaction Surveys	Form and Instruction	New	Scholars Survey
216054	Medical Rehabilitation Research Infrastructure Network (MRRIN) Pilot Project Customer Satisfaction Survey	Form and Instruction	New	MRRIN Pilot Project Survey
215119	Media-Smart Youth® Teen Leaders Program: Nonprofit Partner Satisfaction Survey	Form and Instruction	New	MSY Teen Leaders Nonprofit Partner Final Survey
215115	Media-Smart Youth® Teen Leaders Program: Midpoint Program Satisfaction Survey for Teen Leaders	Form and Instruction	New	MSY Teen Leaders_Midpoint Survey
215109	Media-Smart Youth® Teen Leaders Program: Final Program Satisfaction Survey for Teen Leaders	Form and Instruction	New	MSY Teen Leaders Final Survey
215102	Media-Smart Youth® Teen Leaders Program: Advisor Satisfaction Survey (Priv-Sect)	Form and Instruction	New	MSY Teen Leaders Advisor Final Survey
215051	Media-Smart Youth® Teen Leaders Program: Advisor Satisfaction Survey (Indiv-HH)	Form and Instruction	New	MSY Teen Leaders Advisor Final Survey
214906	NICHD Safe to Sleep® Campaign High-Risk States Outreach Program Customer Satisfaction Survey	Form and Instruction	New	High-risk States Outreach Program Customer Satisfaction Survey
214700	NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	Form and Instruction	New	HNB_Focus Group Guide MOTHERS
214700	NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	Form and Instruction	New	HNB_Focus Group Guide FATHERS
214700	NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	Form and Instruction	New	HNB_Focus Group Guide ELDERS
214700	NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	Form and Instruction	New	HNB_Focus Group Guide HEALTH PROVIDERS
214700	NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	Form and Instruction	New	HNB_Focus Group Guide GENERAL PROVIDERS
214700	NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	Other-Screener	New
214693	NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	Form and Instruction	New	Focus Group Guide MOTHERS
214693	NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	Form and Instruction	New	Focus Group Guide FATHERS
214693	NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	Form and Instruction	New	Focus Group Guide ELDERS
214693	NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	Form and Instruction	New	Focus Group Guide HEALTH PROVIDERS
214693	NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	Form and Instruction	New	Focus Group Guide GENERAL PROVIDERS
214693	NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	Other-Screener	New

ICR Details

OMB Control No: 0925-0643	ICR Reference No: 201410-0925-002
Status: Historical Active	Previous ICR Reference No: 201110-0925-003
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NICHD)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/29/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/09/2014
Terms of Clearance: Previous terms continue: 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	10/31/2017	36 Months From Approved	10/31/2014
Responses	45,600	0	45,600
Time Burden (Hours)	14,850	0	14,850
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (NIH) 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 NICHD's programs.

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

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:
	79 FR 38047	07/03/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 57561	09/25/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 15

table that charts list of burden

IC Title	Form No.	Form Name
NICHD Safe to Sleep® Campaign High-Risk States Outreach Program Customer Satisfaction Survey	1	High-risk States Outreach Program Customer Satisfaction Survey
BIRCWH Principal Investigator, Mentor, and Scholar Satisfaction Surveys	1, 2, 3	Scholars Survey ,   Mentors Survey ,   PI Survey
Beta Test of PregSource™ Crowd-Sourcing to Understand Pregnancy	1	PregSourceBeta Test Survey
Media-Smart Youth® Teen Leaders Program: Advisor Satisfaction Survey (Indiv-HH)	1	MSY Teen Leaders Advisor Final Survey
Media-Smart Youth® Teen Leaders Program: Advisor Satisfaction Survey (Priv-Sect)	1	MSY Teen Leaders Advisor Final Survey
Media-Smart Youth® Teen Leaders Program: Final Program Satisfaction Survey for Teen Leaders	1	MSY Teen Leaders Final Survey
Media-Smart Youth® Teen Leaders Program: Midpoint Program Satisfaction Survey for Teen Leaders	1	MSY Teen Leaders_Midpoint Survey
Media-Smart Youth® Teen Leaders Program: Nonprofit Partner Satisfaction Survey	1	MSY Teen Leaders Nonprofit Partner Final Survey
Medical Rehabilitation Research Infrastructure Network (MRRIN) Pilot Project Customer Satisfaction Survey	1	MRRIN Pilot Project Survey
NICHD Customer Satisfaction Survey on Continuing Education (CE) Activity on Risk Reduction for Sudden Infant Death Syndrom (SIDS) and Other Sleep-Related Causes of Infant Death: Curriculum for Nurses	1	Substudy NICHD Nurse CEP
NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	1, 2, 3, 4, 5	Focus Group Guide GENERAL PROVIDERS ,   Focus Group Guide HEALTH PROVIDERS ,   Focus Group Guide ELDERS ,   Focus Group Guide FATHERS ,   Focus Group Guide MOTHERS
NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	1, 2, 3, 4, 5	HNB_Focus Group Guide GENERAL PROVIDERS ,   HNB_Focus Group Guide HEALTH PROVIDERS ,   HNB_Focus Group Guide ELDERS ,   HNB_Focus Group Guide FATHERS ,   HNB_Focus Group Guide MOTHERS
Nurses' Continuing Education Program on Sudden Infant Death Syndrome (SIDS)	1	Customer Satisfavtion Survey NICHd Nurse CEP
Opportunities for Extramural Collaborations at the NIH Clinical Center (Uo1) Cutomer Satisfaction Interviews	1	Customer Satisfaction Interview protocol
Survey of Researchers Studying Rodent Models for Down Syndrome	1	DS Rodent 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	45,600	45,600	0	0	0	0
Annual Time Burden (Hours)	14,850	14,850	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:

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Annual Cost to Federal Government: $54,736

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: 10/09/2014

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