PregSource Beta Test Clearance request

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

T ITLE OF INFORMATION COLLECTION:

Beta Test of PregSource™--Crowd-Sourcing to Understand Pregnancy (Clinical Exemption 2015-08-001)

PURPOSE:

The NICHD is leading the development of PregSource™, an online resource for collecting data about pregnancy from pregnant women. The final website/application will offer pregnant women, who volunteer, a series of questionnaires related to their health during pregnancy. As we move through production and programming to launch, we want to test the website and application to ensure proper functionality, flow, and understandability. Feedback from this testing will help us refine the interface, functionality, and language of PregSource™ for launch to the general public. The overall PregSource™ project has received a clinical exemption from OMB (2015-08-001); this request is to allow us to collect feedback from test participants about the mechanics of the project via an online survey.

DESCRIPTION OF RESPONDENTS:

Respondents are women who have volunteered their time and effort for this purpose. The respondents were alerted about the testing through organizations that have signed a memo of understanding to support the PregSource™ project. Some of these organizations include the American College of Obstetricians and Gynecologists, the American College of Nurse Midwives, and the Association of Women’s Health, Obstetric, and Neonatal Nurses. The respondents then contacted NICHD to volunteer for the beta testing. They include pregnant women, women who were recently pregnant, and women who may become pregnant in the near future, and women who have not ever been pregnant.

TYPE OF COLLECTION: (Check one)

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

[X ] 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:_Christina Stile, ELS_______________________________________________

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 [X] No

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

Gifts or Payments:

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

We are planning to provide a $20 incentive to those who complete the beta testing. This amount was chosen so as not to be excessive, while also showing our appreciation to the testers for their time.

ESTIMATED BURDEN HOURS and COSTS

Category of Respondent	No. of Respondents	No. of Responses per Respondent	Time per Response (in hours)	Total Burden Hours
Individuals	30	1	20/60	10
Totals	30	30		10

Category of Respondent	Total Burden Hours	Wage Rate*	Total Burden Cost
Individuals	10	$17.401	$5.80
Totals	10	$17.401	$174.00

*Cite source per bls.gov if applicable

FEDERAL COST: The estimated annual cost to the Federal government is $2,140.31

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
1 FTE	12-8	$76,591	1%		$765.91
Contractor Cost		$76,000	1%		$760.00
Travel
Other Cost					$614.40
Total					$2,140.31

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? [ ] Yes [X] No

PregSource™ is intended as a project for pregnant women; therefore we felt that the beta testers should all be female. As described above, respondents have self-selected after receiving a notice about beta testing from a professional organization involved with PregSource™. We intend to use all female respondents who volunteer.

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.

1 http://www.bls.gov/oes/current/oes_nat.htm#00-0000 (all Occupations)

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