NIH Community-Based Participatory Research (CBPR) Grant Programs: Customer Satisfaction Surveys

Generic Clearance for Satisfaction Surveys of Customers (CSR)

Documents and Forms

Document Name Document Type
Form 1 NIH Community-Based Participatory Research (CBPR) Grant Programs: Customer Satisfaction Surveys Form and Instruction
1 PI Satisfaction Survey Attachment A-CBPR PI Satisfaction Survey - screenshots 4-20-16.pdf Form and Instruction
2 Grant PIs Satisfaction Survey Attachment B-Intervention Grant PIs Satisfaction Survey 4-18-16 - screenshots.pdf Form and Instruction
3 Community Partners Satisfaction Survey Attachment C-CBPR Community Partners Satisfaction Survey screenshots 4-18-16 .pdf Form and Instruction
CBPR-Mini Supporting Statement for CSR Generic Clearance 4_15_16.docx Mini SSA IC Document
NIH OD SurveyGizmo for CBPR PIA.docx Privacy Impact Assessment IC Document
Attachment D-Letter 1--OBSSR CBPR PI Customer Satisfaction Survey.docx E-mail Invitation IC Document
Attachment E-Letter 2--OBSSR CBPR Community Partner Customer Satisfaction Survey.docx Email Invitation IC Document
Attachment F-Letter 3--OBSSR Behavioral and Social Intervention Customer Satisfaction Survey.docx Email Invitation IC Document
Attachment G-Letter 4--Madrillon Survey Gizmo Link Follow Up.docx Follow-up Email IC Document
Attachment H-Letter 5--Madrillon Survey Gizmo Link Reminder.docx Email Reminder IC Document

Information Collection (IC) Details

IC Title:	NIH Community-Based Participatory Research (CBPR) Grant Programs: Customer Satisfaction Surveys	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	PI Satisfaction Survey	Attachment A-CBPR PI Satisfaction Survey - screenshots 4-20-16.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	2	Grant PIs Satisfaction Survey	Attachment B-Intervention Grant PIs Satisfaction Survey 4-18-16 - screenshots.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	3	Community Partners Satisfaction Survey	Attachment C-CBPR Community Partners Satisfaction Survey screenshots 4-18-16 .pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,050	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,050	1,050
Annual IC Time Burden (Hours)	353	353
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Mini SSA	CBPR-Mini Supporting Statement for CSR Generic Clearance 4_15_16.docx	04/20/2016
Privacy Impact Assessment	NIH OD SurveyGizmo for CBPR PIA.docx	04/20/2016
E-mail Invitation	Attachment D-Letter 1--OBSSR CBPR PI Customer Satisfaction Survey.docx	04/20/2016
Email Invitation	Attachment E-Letter 2--OBSSR CBPR Community Partner Customer Satisfaction Survey.docx	04/20/2016
Email Invitation	Attachment F-Letter 3--OBSSR Behavioral and Social Intervention Customer Satisfaction Survey.docx	04/20/2016
Follow-up Email	Attachment G-Letter 4--Madrillon Survey Gizmo Link Follow Up.docx	04/20/2016
Email Reminder	Attachment H-Letter 5--Madrillon Survey Gizmo Link Reminder.docx	04/20/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.