Fast Track Submission Form

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0925-0643 Exp. Date: 10/31/2017)

T ITLE OF INFORMATION COLLECTION: Medical Rehabilitation Research Infrastructure Network (MRRIN) Pilot Project Customer Satisfaction Survey

PURPOSE:

The Medical Rehabilitation Research Infrastructure Network (MRRIN) program was established in 2005 and is funded and administered by the National Center of Medical Rehabilitation Research (NCMRR) within the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), with co-funding from two other NIH Institutes. The MRRIN is a key component to the NICHD mission, which includes “ensuring the health, productivity, independence, and well-being of all people through optimal rehabilitation”. MRRIN was designed to enhance the capability of medical rehabilitation investigators to understand mechanisms of functional recovery and develop therapeutic strategies that can improve the lives of people with disabilities. The MRRIN network comprises seven centers around the United States, providing rehabilitation scientists with research infrastructure and access to expertise, technologies, and resources from scientific fields including neurosciences, engineering, applied behavior, and the social sciences. Services provided to investigators may include, among others: advanced technology for simulating musculoskeletal dynamics; expert consulting services on the translation and commercialization of rehabilitation applications; genomics and proteomics services and training; funding of pilot projects; tools and resources for working with large administrative datasets; and access to animal models and robotic systems. The purpose of this survey is to assess investigators’ satisfaction with MRRIN services and the application process for receiving pilot project funds.

DESCRIPTION OF RESPONDENTS:

Respondents for this survey are investigators that received a pilot project grant from MRRIN between 2006 and 2014. Approximately 200 investigators received a pilot project grant during this time period.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [X] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [ ] Other: ______________________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: Jennifer Guimond, PhD

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [X] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X] No

ESTIMATED BURDEN HOURS and COSTS

Category of Respondent	No. of Respondents	No. of Responses per Respondent	Time per Response (in hours)	Total Burden Hours
Private Sector (not-for-profit)	200	1	10/60	33
Totals

Category of Respondent	Total Burden Hours	Wage Rate*	Total Burden Cost
Private Sector (not-for-profit)	33	$40.34**	$1,331.22
Totals

*Cite source per bls.gov if applicable

**The wage rate is based on data from the Bureau of Labor Statistics Occupational Employment and Wages for the Life Scientists 19-1099 category as of May 2013 (http://www.bls.gov/oes/current/oes191099.htm). The hourly mean wage for the Scientific Research and Development Services Industry is $40.34.

FEDERAL COST: The estimated annual cost to the Federal government is $15,336.51.

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight	13/2	$93,851	1%		$938.51
Contractor Cost	Analyst 1	$89.05/hour	160 hours	NA	$14,248
Travel
Other Cost	Survey Gizmo Service	$75.00/month	2 months		$150

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [X] Yes [ ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

The universe of potential respondents is investigators that received a pilot project grant from MRRIN between 2006 and 2014. Approximately 200 investigators received a pilot project grant during this time period. We intend to invite all pilot project investigators to complete the survey and we expect an 80% response rate.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[X] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [X] No

Please make sure that all instruments, instructions, and scripts are submitted with the request.

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