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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Desk Survey May 2018	Form	New	Available
Form 1 NINR Survey screenshots	Form and Instruction	New	Available
Form 1 NINR Survey instrument	Form and Instruction	New	Available
Form 1 WiTS Focus Group	Form and Instruction	New	Available
Form 2 NEI Mod Guide	Form and Instruction	New	Available
Form 1 NEI Screener	Form and Instruction	New	Available
Form 1 Professional Coalition for Research Progress Meeting Assessment form	Form	New	Available
Form 2 SIS Emerging Adults Web Based Survey instrument	Form	New	Available
Form 1 SIS Emerging Adults Focus Group survey instrument	Form and Instruction	New	Available
Form 1 HMD 2018 Exhibition Web Usability Study instrument	Form	New	Available
Form 1 PEPH Aware-Act-Use	Form	New	Available
Form 1 PEP Aware-Act-Use survey	Form	New	Available
Form 1 PEPH Aware-Act-Use Survey	Form	New	Available
Form 1 PEPH Aware-Act-Use instrument	Form	New	Available
Form 1 NCBI 2018 Genetics and Population Frequency Data instrument	Form	New	Available
Form 1 NLM 2018 Public Libraries urvey	Form	New	Available
Form 1 NLM Toxnet 2018 Workshop Survey Instrument	Form and Instruction	New	Available
Form 1 DVR Needs Assessment Survey	Form	New	Available
Form 1 NIGMS CRCB IDeA Core Supplement Follow-up Questions	Form	New	Available
Form 1 NCBI 2018 Literature Resources Survey	Form	New	Available
Form 1 MtG Customer Satisfaction Survey - survey Monkey Screnshot	Form	New	Available
Form 1 NCBI 2018 Representative Genomes survey instrument	Form	New	Available
Form 1 HRCARD Survey Questions	Form	New	Available
Form 1 NRC NIH IP P Survey	Form and Instruction	New	Available
Form 1 Retiree Survey	Form	New	Available
Form 1 Outsell NIH Forecasting Science Survey	Form	New	Available
Form 1 Survey	Form	New	Available
Form 1 NIH Stats Survey 2017	Form	New	Available
Form 1 NIH Rockledge Visual Vocabulary Survey	Form and Instruction	New	Available
Form 1 Obesity Methods P2P Survey	Form	New	Repair queued
Form 1 NLM AIDSource 2017 Survey	Form	New	Available
Form 1 OER Intercept Survey questions	Form	New	Available
Form 1 NCBI Medical Genetics 2017 Survey Instrument	Form	New	Available
Form 1 NLM Websites Survey	Form	New	Available
Form 1 NIH OOCCR Feedback Survey	Form and Instruction	New	Available
Form 1 NCBI BLAST Web Services 2017 Survey Instrument	Form	New	Available
Form 1 BYOMM After Action	Form and Instruction	New	Available
Form 1 BYOMM KAB Form	Form and Instruction	New	Available
Form 1 Weekend Use Nov 2017 Survey	Form and Instruction	New	Available
Form 1 CHEAR Client Satisfaction Survey	Form and Instruction	New	Available
Form 1 FY17 EM Video Production Survey	Form and Instruction	New	Available
Form 1 FY17 EM Scheduling Services Survey	Form and Instruction	New	Available
Form 1 FY17 EM Post Production Survey	Form and Instruction	New	Available
Form 1 FY 17 EM Audio Visual Survey	Form and Instruction	New	Available
Form 1 Workplace Organizational Performance Survey	Form and Instruction	New	Available
Form 1 FY2018 LRP Webinar Survey	Form and Instruction	New	Available
Form 1 NCBI Sequence Database User Survey	Form	New	Available
Form 1 OHR Website survey	Form	New	Available
Form 1 Change Readiness Survey	Form	New	Available
Form 1 NLM NCBI CT Usability Survey	Form	New	Repair queued
Form 1 2017 OHR Climate Survey	Form	New	Available
Form 1 NLM MedlinePlus Survey Instrument	Form	New	Available
Form 1 DSSEM Application and Interview Survey	Form and Instruction	New	Available
Form 1 Sit Visit Survey Questions	Form	New	Available
Form 1 NCBI 2017 Website User Survey Instrument	Form	New	Available
Form 1 CSR Questions MAG	Form	New	Available
Form 1 NLM Main Website Satisfaction Survey Instrument	Form	New	Available
Form 1 Chair Fair Survey	Form and Instruction	New	Available
Form 1 NLM NCBI Microbe Conference Survey Instrument	Form and Instruction	New	Available
Form 1 NLM NCBI CT.gov Website User Survey Instrument	Form	New	Available
Form 1 Medical Arts Branch Survey	Form and Instruction	New	Available
Form 1 Needs Analysis Interview Protocol	Form	New	Available
Form 1 DIS Immigration Conference Evaluation Survey	Form	New	Available
Form 1 2 General CTSU Website Survey	Form and Instruction	New	Available
Form 1 1 NCA Survey	Form and Instruction	New	Available
Form 1 (Screenshots) KAI Research Questions for NIAMS Customer Survey	Form and Instruction	New	Available
Form 1 KAI Research Questions for NIAMS Customer Survey	Form and Instruction	New	Available
Form 1 2017 GSRP Website Survey	Form	New	Available
Form 1 2107 GSRP Survey	Form	New	Available
Form 1 NCI OSFM Shuttle Service Survey Instrument	Form and Instruction	New	Available
Form 1 Survey	Form and Instruction	New	Available
Form 1 Lab Relocation	Form	New	Available
Form 1 NCI OSFM Fitness Survey	Form	New	Available
Form 1 NCI OFSM Relocation Survey - Office Moves	Form	New	Available
Form 1 Express Services Survey	Form	New	Available
Form 1 Survey	Form	New	Available
Form 1 SurveyMonkey SBM Evaluation	Form and Instruction	New	Available
Form 1 NIHTC Training Evaluation- Meeting Facilitation	Form and Instruction	New	Available
Form 1 FY17 Animal Transportation Survey	Form	New	Available
Form 1 Animal Services Survey	Form	New	Repair queued
Form 1 Animal Procurement Survey	Form	New	Available
Form 1 NLM NCBI ClinVar 2017 Survey Instrument	Form and Instruction	New	Available
Form 1 Survey screenshot	Form and Instruction	New	Available
Form 1 NLM MedlinePlus Google Survey Instrument (screenshots)	Form and Instruction	New	Available
Form 1 NLM LO Customer Service Survey Instrument	Form and Instruction	New	Available
Form 1 WiTS Focus Group instrument	Form	New	Available
Form 1 NLM NCBI Gene Resources Website User Survey Instrument	Form and Instruction	New	Available
Form 1 DICE Focus Group Questions	Form	New	Available
Form 1 EX Workforace Analysis Discussion Guide	Form and Instruction	New	Available
Form 1 EX Workforace Analysis Focus Group Discussion Guide	Form and Instruction	New	Available
Form ODS Interview Guid 1	Form and Instruction	New	Available
Form 1 ODS Interview Guide for AMRA Stakeholders	Form and Instruction	New	Available
Form 1 NLM DOCLINE Customer Service Survey Instrument	Form and Instruction	New	Available
Form 2 NIHAOP Survey Mock-up - NRC Health	Form and Instruction	New	Available
Form 1 NIHAIP Survey Mock-up - NRC Health	Form and Instruction	New	Available
Form 1 NIDA- Website Feedback Survey Screenshots	Form and Instruction	New	Available
Form 1 NIMH Employee Engangement Survey	Form and Instruction	New	Available
Form 1 NLM MedlinePlus Google Survey Instrument	Form and Instruction	New	Available
Form 1 Survey 2016 HRHR Symposium screenshot	Form and Instruction	New	Available
Form 1 NLM GHR Use Study Interview Instrument	Form and Instruction	New	Available
Form 1 NLM LIS User Survey Instrument	Form and Instruction	New	Available
Form 1 NLM GHR User Study Screening Survey Instrument	Form and Instruction	New	Available
Form 1 FRLC Communication Survey Screenshots	Form and Instruction	New	Available
Form 1 2016 BRAIN PI Meeting Survey Screenshots	Form and Instruction	New	Available
Form 1 LRP Survey for Applicants Form C-Screenshots	Form and Instruction	New	Available
Form 1 LRP Survey for Applicants Form B- Screenshot	Form and Instruction	New	Available
Form 1 LRP Survey for Applicants Form A- Screenshots	Form and Instruction	New	Available
Form 1 MOOC Survey	Form	New	Available
Form 1 NLM ToxTutor User Survey Instrument	Form and Instruction	New	Available
Form 1 Qualtrics Print	Form and Instruction	New	Repair queued
Form 1 LRP Survey for Mentors-Screenshots 2	Form and Instruction	New	Available
Form 1 LRP Survey for Mentors- Screenshots	Form and Instruction	New	Available
Form 1 LRP Referee Survey- Screenshots	Form and Instruction	New	Available
Form 1 LRP IBO Survey- Screenshots	Form and Instruction	New	Available
Form 1 NLM 4 Caregivers 2016 User Survey Instrument	Form and Instruction	New	Available
Form 1 LRP Qualitative Research	Form and Instruction	New	Available
Form 1 LRP Ambassador Feedback	Form and Instruction	New	Available
Form 2 Reviewer questions	Form	New	Available
Form 1 Applicant survey	Form	New	Available
Form 1 NLM Medline Plus RML User Survey Instrument	Form	New	Available
Form 1 2016 HHS Learning Portal (LMS)	Form	New	Available
Form 1 NLM NCBI CDDS Survey Instrument	Form	New	Available
Form 1 OM All Hands Survey	Form and Instruction	New	Available
Form 1 Patient Portal Online Survey Screenshot	Form and Instruction	New	Available
Form 1 NLM Traveling Exhibition Visitor Survey	Form and Instruction	New	Available
Form 1 2016 Flu Survey	Form	New	Available
Form 1 NLM ClinVar 2016 User Survey Instrument	Form	New	Available
Form 1 LRP Webinar Survey	Form and Instruction	New	Available
Form 2 NIDCR Focus Group Recruitment Screener	Form and Instruction	New	Available
Form 1 NIDCR-FG Moderator Guide	Form and Instruction	New	Available
Form 1 HHS SBIR Showcase Event Feedback Form	Form	New	Available
Form 2 FRLC Post-Conference Survey Screenshot	Form and Instruction	New	Available
Form 1 FRLC pre-conference survey screenshot	Form and Instruction	New	Available
Form 1 OITE-OMBFT- Community College Day- Feedback Collection	Form	New	Available
Form 1 Graduate and Professional School Fair Feedback Collection	Form	New	Available
Form 1 Survey Instrument	Form and Instruction	New	Available
Form 2 Survey Instrument Web Questions	Form and Instruction	New	Available
Form 1 Survey Instrument IVR	Form and Instruction	New	Available
Form 1 IntraHR Customer Satisfaction Survey	Form and Instruction	New	Available
Form 1 Usability Test Questions	Form and Instruction	New	Available
Form 1 Survey Screenshot	Form and Instruction	New	Available
Form 1 CAREER SYMPOSIUM FEEDBACK	Form and Instruction	New	Available
Form 1 MANAGEMENT BOOT CAMP FEEDBACK Form	Form and Instruction	New	Available
Form 2 CAREER SERVICES CENTER	Form and Instruction	New	Available
Form 1 FEEDBACK ON AN OITE EVENT	Form and Instruction	New	Available
Form 1 Survey	Form and Instruction	New	Available
Form 1 Focus Group Questions	Form and Instruction	New	Available
Form 1 Survey Screenshot	Form and Instruction	New	Available
Form 1 Survey Screenshot	Form and Instruction	New	Available
Form 1 Email Survey	Form and Instruction	New	Available
Form 1 OAS Shuttle Survey Screenshots	Form and Instruction	New	Available
Form 3 Trainee Survey	Form and Instruction	New	Available
Form 2 Faculty Survey	Form and Instruction	New	Available
Form 1 Applicants Survey	Form and Instruction	New	Available
Form 1 NLM NCBI GRC Website User Survey Instrument	Form and Instruction	New	Available
Form 1 NLM NCBI Health Resource Survey screenshots	Form and Instruction	New	Available
Form 1 NLM MedlinePlus Usability Testing ICR Instrument	Form and Instruction	New	Available
Form 2 USJCP Meeting feedback form	Form and Instruction	New	Available
Form 1 USJCP Meeting screenshots	Form and Instruction	New	Available
Form 1 Host Survey	Form and Instruction	New	Available
Form 1 NIH Blog Survey	Form and Instruction	New	Available
Form 1 2015 WiTS Climate Survey	Form and Instruction	New	Available
Form 2 Survey (paper version)	Form and Instruction	New	Available
Form 1 Survey Screenshots	Form and Instruction	New	Available
Form 1 Customer Satisfaction Survey	Form and Instruction	New	Available
Form 1 Customer Satisfaction Survey	Form and Instruction	New	Available
Form 3 Telephone services survey	Form and Instruction	New	Available
Form 2 Online publications ordering services survey	Form and Instruction	New	Available
Form 1 Email services survey	Form and Instruction	New	Available
Form 1 NIMH Website Survey	Form and Instruction	New	Available
Form 1 KAI Annual Client Survey Printscreens	Form and Instruction	New	Available
Form 1 HRSS Survey	Form and Instruction	New	Available
Form 1 IMT Intercept survey Form	Form and Instruction	New	Available
Form 1 Survey Instrument	Form and Instruction	New	Available
Form 1 NLM Variation Resources User Survey	Form and Instruction	New	Available
Form 1 Survey Screenshot	Form and Instruction	New	Available
Form 2 Email Survey	Form and Instruction	New	Available
Form 1 Telephone Survey	Form and Instruction	New	Available
Form 1 HR Training Survey	Form and Instruction	New	Available
Form 1 Pain Survey	Form and Instruction	New	Available
Form 1 Pain Survey	Form and Instruction	New	Available
Form 1 OHR Pulse Survey	Form and Instruction	New	Available
Form 5 Child Assent Form	Form and Instruction	New	Available
Form 4 Parent Consent Form and Scriot	Form and Instruction	New	Available
Form 3 Teacher Consent Form and Script	Form and Instruction	New	Repair queued
Form 2 Clinical Professional Consent Form and Script	Form and Instruction	New	Available
Form 1 Screeners	Form and Instruction	New	Available
Form 1 2015 NIH Single Cell Analysis Investigators Meeting Survey	Form and Instruction	New	Available
Form 1 NLM PubMed Search User Survey	Form and Instruction	New	Available
Form 1 Key Informant Interview Guide	Form and Instruction	New	Available
Form 1 Survey Screenshots	Form and Instruction	New	Available
Fast Track Template.doc	Supplementary Document	Uploaded 2015-01-28	Available
SSB_0925-0648_NIH Wide Fast Track Extension.docx	Supporting Statement B	Uploaded 2015-01-28	Available
SSA Generic NIHWide Fast Track1.docx	Supporting Statement A	Uploaded 2015-01-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
230704	NIH Library Customer Satisfaction Survey	Form	New	Desk Survey May 2018
230693	Basic electronic survey to inform development of a nursing research brochure (NINR)	Form and Instruction	New	NINR Survey screenshots
230693	Basic electronic survey to inform development of a nursing research brochure (NINR)	Form and Instruction	New	NINR Survey instrument
230689	Workflow information Tracking System (WiTS) Focus Groups (OD)	Form and Instruction	New	WiTS Focus Group
230574	NEI Health Focus Groups with New Audiences Ages 25-35	Form and Instruction	New	NEI Mod Guide
230574	NEI Health Focus Groups with New Audiences Ages 25-35	Form and Instruction	New	NEI Screener
230549	NIMH Professional Coalition for Research Progress Meeting Assessment Form	Form	New	Professional Coalition for Research Progress Meeting Assessment form
230502	2018 NLM SIS Emerging Adults Health Needs Assessment	Form	New	SIS Emerging Adults Web Based Survey instrument
230502	2018 NLM SIS Emerging Adults Health Needs Assessment	Form and Instruction	New	SIS Emerging Adults Focus Group survey instrument
230499	HMD 2018 Exhibition Program Web Usability Study	Form	New	HMD 2018 Exhibition Web Usability Study instrument
230409	Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Federal Government)	Form	New	PEPH Aware-Act-Use
230407	Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (State, Local or Tribal)	Form	New	PEP Aware-Act-Use survey
230406	Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Private Sector)	Form	New	PEPH Aware-Act-Use Survey
230405	Partnerships for Environmental Public Health Program (PEPH) Aware-Act-Use Survey (Individuals/households)	Form	New	PEPH Aware-Act-Use instrument
230393	NCBI 2018 Genetics and Population Frequency Data Survey (NLM)	Form	New	NCBI 2018 Genetics and Population Frequency Data instrument
230245	NLM 2018 Public Libraries Association Survey	Form	New	NLM 2018 Public Libraries urvey
230205	NLM TOXNET 2018 Workshop Survey	Form and Instruction	New	NLM Toxnet 2018 Workshop Survey Instrument
230048	DVR Animal Services Needs Assessment	Form	New	DVR Needs Assessment Survey
230014	Outcomes of IDeA Core Optimization Administrative Supplements	Form	New	NIGMS CRCB IDeA Core Supplement Follow-up Questions
230013	NLM NCBI 2018 Literature Resources Survey	Form	New	NCBI 2018 Literature Resources Survey
229947	Medicine: NIH Mind the Gap Webinar Series Survey II	Form	New	MtG Customer Satisfaction Survey - survey Monkey Screnshot
229825	NLM NCBI 2018 Representative Genomes Survey	Form	New	NCBI 2018 Representative Genomes survey instrument
229776	Human Resources Classification and Recruitment Documents System (HR CARDS) Survey	Form	New	HRCARD Survey Questions
229752	Pediatric Patient Perception Survey (CC)	Form and Instruction	New	NRC NIH IP P Survey
229487	Benefits & Payroll Liaison Branch (BLPB) Customer Satisfaction Survey	Form	New	Retiree Survey
229458	Forecasting Science Survey	Form	New	Outsell NIH Forecasting Science Survey
229455	The NIH Director's Blog Readership Survey	Form	New	Survey
229385	NIH Library Survey on Statistical Class Offerings	Form	New	NIH Stats Survey 2017
229190	ORF Workplace Aesthetic Survey (OD)	Form and Instruction	New	NIH Rockledge Visual Vocabulary Survey
229113	ODP Pathways to Prevention Survey II	Form	New	Obesity Methods P2P Survey
229104	NLM AIDSource 2017 Survey	Form	New	NLM AIDSource 2017 Survey
229073	OER Intercept survey	Form	New	OER Intercept Survey questions
228994	NCBI Medical Genetics and Variation Web Resources 2017 Survey	Form	New	NCBI Medical Genetics 2017 Survey Instrument
228776	NLM Website Survey for Website Satisfaction Rating	Form	New	NLM Websites Survey
228700	Ombudsman Services Feedback Survey	Form and Instruction	New	NIH OOCCR Feedback Survey
228637	NCBI BLAST Web Services 2017 Survey	Form	New	NCBI BLAST Web Services 2017 Survey Instrument
228636	Brother, You're on My Mind (BYOMM) After Action Report	Form and Instruction	New	BYOMM After Action
228634	Brother, You're on My Mind (BYOMM) Knowledge Attitudes and Believes Form	Form and Instruction	New	BYOMM KAB Form
228615	NIH Library Survey: Weekend Library Use	Form and Instruction	New	Weekend Use Nov 2017 Survey
228545	Children's Health Exposure Assessment Resource (CHEAR) Client Satisfaction Survey	Form and Instruction	New	CHEAR Client Satisfaction Survey
228342	NIH Events Management – Video Production Survey	Form and Instruction	New	FY17 EM Video Production Survey
228341	NIH Events Management – Scheduling Services Survey	Form and Instruction	New	FY17 EM Scheduling Services Survey
228340	NIH Events Management – Post Production Survey	Form and Instruction	New	FY17 EM Post Production Survey
228339	NIH Events Management – Audio Visual Survey	Form and Instruction	New	FY 17 EM Audio Visual Survey
228336	Workplace and Organizational Performance Survey	Form and Instruction	New	Workplace Organizational Performance Survey
228325	The NIH Extramural Loan Repayment Programs: Online Customer Service Survey About the Application Technical Assistance Webinar	Form and Instruction	New	FY2018 LRP Webinar Survey
228233	NCBI 2017 Sequence Database User Survey	Form	New	NCBI Sequence Database User Survey
228024	OHR Website Customer Satisfaction Survey	Form	New	OHR Website survey
227960	Change Readiness Survey	Form	New	Change Readiness Survey
227851	NLM NCBI ClinicalTrials.gov Website Usability Survey 2017	Form	New	NLM NCBI CT Usability Survey
227845	Office of Human Resources (OHR) Climate Survey	Form	New	2017 OHR Climate Survey
227759	NLM Survey for MedlinePlus Page Satisfaction	Form	New	NLM MedlinePlus Survey Instrument
227714	DSSEM Application and Interview Satisfaction Survey	Form and Instruction	New	DSSEM Application and Interview Survey
227642	Customer Satisfaction with the Contribution of Site Visits to Assess Institutional Training Grant Applications (NIGMS)	Form	New	Sit Visit Survey Questions
227452	NCBI 2017 Website User Survey	Form	New	NCBI 2017 Website User Survey Instrument
227241	CSR Poll on Grant Award Productivity using the Relative Citation Ratio (RCR)	Form	New	CSR Questions MAG
227102	NLM Main Website Satisfaction Survey	Form	New	NLM Main Website Satisfaction Survey Instrument
227077	Chair Survey	Form and Instruction	New	Chair Fair Survey
227077	Chair Survey	Other-E-mail	New
226938	NLM NCBI Microbe Conference Survey	Form and Instruction	New	NLM NCBI Microbe Conference Survey Instrument
226886	NLM NCBI ClinicalTrials.gov Website User Survey	Form	New	NLM NCBI CT.gov Website User Survey Instrument
226868	Medical Arts Branch (MAB) Services Survey	Form and Instruction	New	Medical Arts Branch Survey
226868	Medical Arts Branch (MAB) Services Survey	Other-Email	New
226628	Pathways for Teamwork Customer Satisfaction Interviews	Form	New	Needs Analysis Interview Protocol
226567	DIS Immigration Conference Evaluation Survey	Form	New	DIS Immigration Conference Evaluation Survey
226567	DIS Immigration Conference Evaluation Survey	Other-E-mail	New
226437	CTSU Website Customer Satisfaction Surveys	Form and Instruction	New	2 General CTSU Website Survey
226437	CTSU Website Customer Satisfaction Surveys	Form and Instruction	New	1 NCA Survey
226348	Data and Safety Monitoring Meeting Evaluation	Form and Instruction	New	KAI Research Questions for NIAMS Customer Survey
226348	Data and Safety Monitoring Meeting Evaluation	Form and Instruction	New	KAI Research Questions for NIAMS Customer Survey
226276	2017 GSRP Website Survey Applicant	Form	New	2017 GSRP Website Survey
226275	2017 Graduate Student Recruitment Program (GSRP)	Form	New	2107 GSRP Survey
226261	NCI OSFM Shuttle Service Survey	Form and Instruction	New	NCI OSFM Shuttle Service Survey Instrument
226259	NCI OSFM Conference Room Services Survey	Form and Instruction	New	Survey
226257	NCI OSFM Relocation Survey- Lab	Form	New	Lab Relocation
226256	NCI OSFM Fitness Center Survey	Form	New	NCI OSFM Fitness Survey
226246	NCI OFSM Relocation Survey - Office	Form	New	NCI OFSM Relocation Survey - Office Moves
226245	NCI OSFM Express Services Survey	Form	New	Express Services Survey
226231	NCI OSFM Small Little Job (SLJ) Survey	Form	New	Survey
226166	"The Nuts and Bolts of Group Randomized Trials" Participant Feedback Survey	Form and Instruction	New	SurveyMonkey SBM Evaluation
226141	NIH Training Center Meeting Facilitation Survey	Form and Instruction	New	NIHTC Training Evaluation- Meeting Facilitation
226135	DVR Customer Service Survey - Animal Transportation Services	Form	New	FY17 Animal Transportation Survey
226134	DVR Cutomer Service Survey - Animal Services	Form	New	Animal Services Survey
226016	DVR Customer Service Survey - Animal Procurement	Form	New	Animal Procurement Survey
226014	NLM ClinVar 2017 Website User Survey	Form and Instruction	New	NLM NCBI ClinVar 2017 Survey Instrument
225739	Participant Feedback on 2017 NIH Common Fund 2017 Stimulating Peripheral Activity to Relieve Conditions (SPARC) Research Program Annual Awardee Meeting	Form and Instruction	New	Survey screenshot
225540	NLM MedlinePlus Page Google Survey Satisfaction Rating	Form and Instruction	New	NLM MedlinePlus Google Survey Instrument (screenshots)
225479	NLM Library Operations Customer Satisfaction Survey	Form and Instruction	New	NLM LO Customer Service Survey Instrument
225379	Workflow Information Tracking System (WiTS) Focus Groups	Form	New	WiTS Focus Group instrument
225298	NLM NCBI Gene Resources Website Survey	Form and Instruction	New	NLM NCBI Gene Resources Website User Survey Instrument
225281	Drupal Implementation and Content Enhancement (DICE) Focus Groups	Form	New	DICE Focus Group Questions
225233	National Institute of Mental Health (NIMH) Office of the Director and Extramural Programs Workforce Resource Analysis	Form and Instruction	New	EX Workforace Analysis Discussion Guide
225233	National Institute of Mental Health (NIMH) Office of the Director and Extramural Programs Workforce Resource Analysis	Form and Instruction	New	EX Workforace Analysis Focus Group Discussion Guide
225201	Analytical Methods and Reference Materials Program Stakeholder Interviews (For Profit)	Form and Instruction	New	1
225198	Analytical Methods and Reference Materials Program Stakeholder Interviews (Not for Profit)	Form and Instruction	New	ODS Interview Guide for AMRA Stakeholders
225092	NLM DOCLINE Customer Service Survey	Form and Instruction	New	NLM DOCLINE Customer Service Survey Instrument
225091	Patient Perception Survey (CC)	Form and Instruction	New	NIHAOP Survey Mock-up - NRC Health
225091	Patient Perception Survey (CC)	Form and Instruction	New	NIHAIP Survey Mock-up - NRC Health
224947	DrugAbuse.gov Website Feedback Survey	Form and Instruction	New	NIDA- Website Feedback Survey Screenshots
224929	National Institute of Mental Health (NIMH) Employee Engagement Survey	Form and Instruction	New	NIMH Employee Engangement Survey
224925	NLM Google Survey for MedlinePlus Page Satisfaction Rating	Form and Instruction	New	NLM MedlinePlus Google Survey Instrument
224889	Participant Feedback on 2016 NIH Common Fund High-Risk, High-Reward Research Symposium	Form and Instruction	New	Survey 2016 HRHR Symposium screenshot
224887	NLM Genetic Home Reference User Study	Form and Instruction	New	NLM GHR Use Study Interview Instrument
224855	LIS User Survey of NLM Resources	Form and Instruction	New	NLM LIS User Survey Instrument
224855	LIS User Survey of NLM Resources	Other-Survey Invitation	New
224763	NLM GHR User Study Screening Survey	Form and Instruction	New	NLM GHR User Study Screening Survey Instrument
224737	Future Research Leaders Conference –Communication Survey	Form and Instruction	New	FRLC Communication Survey Screenshots
224736	2016 Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Principle Investigators' (PI) Meeting Post-Conference Evaluation Survey	Form and Instruction	New	2016 BRAIN PI Meeting Survey Screenshots
224690	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form C	Form and Instruction	New	LRP Survey for Applicants Form C-Screenshots
224690	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form C	Other-email	New
224689	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form B	Form and Instruction	New	LRP Survey for Applicants Form B- Screenshot
224689	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form B	Other-Email	New
224687	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form A	Form and Instruction	New	LRP Survey for Applicants Form A- Screenshots
224687	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form A	Other-email	New
224454	Pragmatic & Group-Randomized Trials (GRT) in Public Health & Medicine Participant Feedback Survey: Parts 1-7	Form	New	MOOC Survey
224452	NLM ToxTutor User Survey	Form and Instruction	New	NLM ToxTutor User Survey Instrument
224420	Workstyle Survey	Form and Instruction	New	Qualtrics Print
224420	Workstyle Survey	Other-Survey Email	New
224383	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Award Applicants	Form and Instruction	New	LRP Survey for Mentors-Screenshots 2
224383	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Award Applicants	Other-Invitation Email	New
224382	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Mentors	Form and Instruction	New	LRP Survey for Mentors- Screenshots
224382	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Mentors	Other-Invitation Email	New
224381	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Recommenders/Referees	Form and Instruction	New	LRP Referee Survey- Screenshots
224381	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Recommenders/Referees	Other-Invitation Email	New
224380	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Institutional Business Officials (IBOs)	Form and Instruction	New	LRP IBO Survey- Screenshots
224380	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Institutional Business Officials (IBOs)	Other-Invitation Email	New
224307	NLM 4 Caregivers User Survey	Form and Instruction	New	NLM 4 Caregivers 2016 User Survey Instrument
224162	LRP Qualitative Research	Form and Instruction	New	LRP Qualitative Research
224159	LRP Ambassador Feedback	Form and Instruction	New	LRP Ambassador Feedback
223962	CSR Website Redesign Novice Applicants & Reviewer Interviews	Form	New	Reviewer questions
223962	CSR Website Redesign Novice Applicants & Reviewer Interviews	Form	New	Applicant survey
223918	NLM MedlinePlus RML User Survey	Form	New	NLM Medline Plus RML User Survey Instrument
223902	2016 HHS Learning Portal (LMS) User Survey	Form	New	2016 HHS Learning Portal (LMS)
223817	NLM NCBI CCDS User Survey	Form	New	NLM NCBI CDDS Survey Instrument
223717	OM All Hands Meeting Survey	Form and Instruction	New	OM All Hands Survey
223699	Health Information Technology Patient Satisfaction Survey (CC)	Form and Instruction	New	Patient Portal Online Survey Screenshot
223262	NLM Traveling Exhibition Visitor Study	Form and Instruction	New	NLM Traveling Exhibition Visitor Survey
223254	Influenza Vaccine Survey	Form	New	2016 Flu Survey
223099	NLM ClinVar 2016 User Survey	Form	New	NLM ClinVar 2016 User Survey Instrument
222516	Online Customer Service Survey About The Application Technical Assistance Webinar	Form and Instruction	New	LRP Webinar Survey
222516	Online Customer Service Survey About The Application Technical Assistance Webinar	Other-Invitation Email	New
222437	National Institute of Dental and Craniofacial Research Focus Group Study	Form and Instruction	New	NIDCR Focus Group Recruitment Screener
222437	National Institute of Dental and Craniofacial Research Focus Group Study	Form and Instruction	New	NIDCR-FG Moderator Guide
222338	HHS SBIR/STTR Showcase Conference Feedback	Form	New	HHS SBIR Showcase Event Feedback Form
222336	Future Research Leaders Conference Survey	Form and Instruction	New	FRLC Post-Conference Survey Screenshot
222336	Future Research Leaders Conference Survey	Form and Instruction	New	FRLC pre-conference survey screenshot
222332	NIH Office of Intramural Training & Education (OITE) – Community College Day Feedback	Form	New	OITE-OMBFT- Community College Day- Feedback Collection
222098	NIH Office of Intramural Training & Education (OITE) – Graduate & Professional School Fair Feedback	Form	New	Graduate and Professional School Fair Feedback Collection
222047	NIH Native American Visit Week Feedback	Form and Instruction	New	Survey Instrument
221890	NHLBI's Health Information Center (HIC)	Form and Instruction	New	Survey Instrument Web Questions
221890	NHLBI's Health Information Center (HIC)	Form and Instruction	New	Survey Instrument IVR
221727	IntraHR Website Customer Satisfaction Survey	Form and Instruction	New	IntraHR Customer Satisfaction Survey
221685	National Institute of Dental and Craniofacial Research (NIDCR) Website Usability Study	Form and Instruction	New	Usability Test Questions
221575	Customer Feedback on NIH's Targeted Guidance for New Investigators	Form and Instruction	New	Survey Screenshot
221359	Career Symposium Feedback	Form and Instruction	New	CAREER SYMPOSIUM FEEDBACK
221247	NIH Office of Intramural Training & Education (OITE) – Management Boot Camp Feedback	Form and Instruction	New	MANAGEMENT BOOT CAMP FEEDBACK Form
221149	NIH Office of Intramural Training & Education (OITE) – General Feedback Form	Form and Instruction	New	CAREER SERVICES CENTER
221149	NIH Office of Intramural Training & Education (OITE) – General Feedback Form	Form and Instruction	New	FEEDBACK ON AN OITE EVENT
220938	NLM MedlinePlus Connect Customer Survey	Form and Instruction	New	Survey
220783	NLM Project SHARE website assessment	Form and Instruction	New	Focus Group Questions
220783	NLM Project SHARE website assessment	Other-Consent Form	New
220632	ODP Pathways to Prevention Survey -For Profits	Form and Instruction	New	Survey Screenshot
220631	ODP Pathways to Prevention Survey -Not For Profits	Form and Instruction	New	Survey Screenshot
220346	Awardees Feedback Survey on NHLBI PAR-10-005 and PAR-13-002, NHLBI Clinical Trial Pilot Studies (R34)	Form and Instruction	New	Email Survey
220178	Shuttle Bus Survey for Fishers Lane	Form and Instruction	New	OAS Shuttle Survey Screenshots
219530	NIH Research Training Institutes (RTIs) Customer Satisfaction Surveys	Form and Instruction	New	Trainee Survey
219530	NIH Research Training Institutes (RTIs) Customer Satisfaction Surveys	Form and Instruction	New	Faculty Survey
219530	NIH Research Training Institutes (RTIs) Customer Satisfaction Surveys	Form and Instruction	New	Applicants Survey
219370	NLM NCBI GRC Website User Survey	Form and Instruction	New	NLM NCBI GRC Website User Survey Instrument
219201	NLM NCBI Health Resources Survey	Form and Instruction	New	NLM NCBI Health Resource Survey screenshots
219199	NLM MedlinePlus Website Usability Testing	Form and Instruction	New	NLM MedlinePlus Usability Testing ICR Instrument
219194	US-Japan Cooperative Medical Sciences Program (USJCMSP) 50th Anniversay and 18th International Conference on Emerging Infectious Diseases in the Pacific Rim	Form and Instruction	New	USJCP Meeting feedback form
219194	US-Japan Cooperative Medical Sciences Program (USJCMSP) 50th Anniversay and 18th International Conference on Emerging Infectious Diseases in the Pacific Rim	Form and Instruction	New	USJCP Meeting screenshots
219124	Traveling Exhibition Host Survey	Form and Instruction	New	Host Survey
219124	Traveling Exhibition Host Survey	Other-Email	New
219012	The NIH Director's Blog Readership Survey	Form and Instruction	New	NIH Blog Survey
219000	WiTS Climate Survey 2015	Form and Instruction	New	2015 WiTS Climate Survey
218992	NLM Reading Rooms Satisfaction Survey	Form and Instruction	New	Survey (paper version)
218992	NLM Reading Rooms Satisfaction Survey	Form and Instruction	New	Survey Screenshots
218941	Medicine: Mind the Gap NIH Seminar Series Survey-Not-For-Profits	Form and Instruction	New	Customer Satisfaction Survey
218939	Medicine: Mind the Gap NIH Seminar Series Survey-For Profits	Form and Instruction	New	Customer Satisfaction Survey
218616	NIMH Information Resource Center (IRC) Customer Satisfaction Surveys for Email Information Services, Online Publications Ordering Services and Telephone Services	Form and Instruction	New	Telephone services survey
218616	NIMH Information Resource Center (IRC) Customer Satisfaction Surveys for Email Information Services, Online Publications Ordering Services and Telephone Services	Form and Instruction	New	Online publications ordering services survey
218616	NIMH Information Resource Center (IRC) Customer Satisfaction Surveys for Email Information Services, Online Publications Ordering Services and Telephone Services	Form and Instruction	New	Email services survey
218505	NIMH Website Survey	Form and Instruction	New	NIMH Website Survey
218063	KAI Annual Client Satisfaction Survey	Form and Instruction	New	KAI Annual Client Survey Printscreens
218050	HR Systems Support (HRSS) Customer Satisfaction Survey	Form and Instruction	New	HRSS Survey
217979	Information Management Team (IMT) Web Intercept Survey	Form and Instruction	New	IMT Intercept survey Form
217974	NLM Customer Service Satisfaction Survey	Form and Instruction	New	Survey Instrument
217821	Variation Resources Survey	Form and Instruction	New	NLM Variation Resources User Survey
217582	Usability testing for PHPartners.org website	Form and Instruction	New	Survey Screenshot
217316	NCCIH Customer Service Data Collection	Form and Instruction	New	Email Survey
217316	NCCIH Customer Service Data Collection	Form and Instruction	New	Telephone Survey
217040	Office of Human Resources (OHR) Training Survey	Form and Instruction	New	HR Training Survey
217029	The Annual NIH Pain Consortium Symposium Feedback (Not For Profit)	Form and Instruction	New	Pain Survey
217028	The Annual NIH Pain Consortium Symposium Feedback (For Profit)	Form and Instruction	New	Pain Survey
216455	Office of Human Resources (OHR) Pulse Survey	Form and Instruction	New	OHR Pulse Survey
216184	Educational Game Focus Group	Form and Instruction	New	Child Assent Form
216184	Educational Game Focus Group	Form and Instruction	New	Parent Consent Form and Scriot
216184	Educational Game Focus Group	Form and Instruction	New	Teacher Consent Form and Script
216184	Educational Game Focus Group	Form and Instruction	New	Clinical Professional Consent Form and Script
216184	Educational Game Focus Group	Form and Instruction	New	Screeners
216146	2015 NIH Single Cell Analysis Investigators Meeting Survey	Form and Instruction	New	2015 NIH Single Cell Analysis Investigators Meeting Survey
216076	PubMed Search User Survey	Form and Instruction	New	NLM PubMed Search User Survey
215724	Qualitative Research to Explore Barriers and Facilitators for LRP Ambassadors to Promote the NIH Loan Repayment Programs	Form and Instruction	New	Key Informant Interview Guide
215637	Community Health Maps Project User Survey	Form and Instruction	New	Survey Screenshots

ICR Details

OMB Control No: 0925-0648	ICR Reference No: 201501-0925-004
Status: Historical Active	Previous ICR Reference No: 201112-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)
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: 03/04/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/29/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2018	36 Months From Approved	03/31/2015
Responses	759,000	0	759,000
Time Burden (Hours)	148,074	0	148,074
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable the National Institutes of Health 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 the agency's programs.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 69500	11/21/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 4934	01/29/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 168

table that charts list of burden

IC Title	Form No.	Form Name
"The Nuts and Bolts of Group Randomized Trials" Participant Feedback Survey	1	SurveyMonkey SBM Evaluation
2015 NIH Single Cell Analysis Investigators Meeting Survey	1	2015 NIH Single Cell Analysis Investigators Meeting Survey
2016 Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Principle Investigators' (PI) Meeting Post-Conference Evaluation Survey	1	2016 BRAIN PI Meeting Survey Screenshots
2016 HHS Learning Portal (LMS) User Survey	1	2016 HHS Learning Portal (LMS)
2017 GSRP Website Survey Applicant	1	2017 GSRP Website Survey
2017 Graduate Student Recruitment Program (GSRP)	1	2107 GSRP Survey
2018 NLM SIS Emerging Adults Health Needs Assessment	2, 1	SIS Emerging Adults Focus Group survey instrument ,   SIS Emerging Adults Web Based Survey instrument
Analytical Methods and Reference Materials Program Stakeholder Interviews (For Profit)	ODS Interview Guide for AMRA Stakeholders	1
Analytical Methods and Reference Materials Program Stakeholder Interviews (Not for Profit)	1	ODS Interview Guide for AMRA Stakeholders
Awardees Feedback Survey on NHLBI PAR-10-005 and PAR-13-002, NHLBI Clinical Trial Pilot Studies (R34)	1	Email Survey
Basic electronic survey to inform development of a nursing research brochure (NINR)	1, 1	NINR Survey instrument ,   NINR Survey screenshots
Benefits & Payroll Liaison Branch (BLPB) Customer Satisfaction Survey	1	Retiree Survey
Brother, You're on My Mind (BYOMM) After Action Report	1	BYOMM After Action
Brother, You're on My Mind (BYOMM) Knowledge Attitudes and Believes Form	1	BYOMM KAB Form
CSR Poll on Grant Award Productivity using the Relative Citation Ratio (RCR)	1	CSR Questions MAG
CSR Website Redesign Novice Applicants & Reviewer Interviews	2, 1	Applicant survey ,   Reviewer questions
CTSU Website Customer Satisfaction Surveys	1, 1	1 NCA Survey ,   2 General CTSU Website Survey
Career Symposium Feedback	1	CAREER SYMPOSIUM FEEDBACK
Chair Survey	1	Chair Fair Survey
Change Readiness Survey	1	Change Readiness Survey
Children's Health Exposure Assessment Resource (CHEAR) Client Satisfaction Survey	1	CHEAR Client Satisfaction Survey
Community Health Maps Project User Survey	1	Survey Screenshots
Customer Feedback on NIH's Targeted Guidance for New Investigators	1	Survey Screenshot
Customer Satisfaction with the Contribution of Site Visits to Assess Institutional Training Grant Applications (NIGMS)	1	Sit Visit Survey Questions
DIS Immigration Conference Evaluation Survey	1	DIS Immigration Conference Evaluation Survey
DSSEM Application and Interview Satisfaction Survey	1	DSSEM Application and Interview Survey
DVR Animal Services Needs Assessment	1	DVR Needs Assessment Survey
DVR Customer Service Survey - Animal Procurement	1	Animal Procurement Survey
DVR Customer Service Survey - Animal Transportation Services	1	FY17 Animal Transportation Survey
DVR Cutomer Service Survey - Animal Services	1	Animal Services Survey
Data and Safety Monitoring Meeting Evaluation	1 (Screenshots), 1	KAI Research Questions for NIAMS Customer Survey ,   KAI Research Questions for NIAMS Customer Survey
DrugAbuse.gov Website Feedback Survey	1	NIDA- Website Feedback Survey Screenshots
Drupal Implementation and Content Enhancement (DICE) Focus Groups	1	DICE Focus Group Questions
Educational Game Focus Group	1, 4, 5, 2, 3	Screeners ,   Clinical Professional Consent Form and Script ,   Teacher Consent Form and Script ,   Parent Consent Form and Scriot ,   Child Assent Form
Forecasting Science Survey	1	Outsell NIH Forecasting Science Survey
Future Research Leaders Conference Survey	1, 2	FRLC pre-conference survey screenshot ,   FRLC Post-Conference Survey Screenshot
Future Research Leaders Conference –Communication Survey	1	FRLC Communication Survey Screenshots
HHS SBIR/STTR Showcase Conference Feedback	1	HHS SBIR Showcase Event Feedback Form
HMD 2018 Exhibition Program Web Usability Study	1	HMD 2018 Exhibition Web Usability Study instrument
HR Systems Support (HRSS) Customer Satisfaction Survey	1	HRSS Survey
Health Information Technology Patient Satisfaction Survey (CC)	1	Patient Portal Online Survey Screenshot
Human Resources Classification and Recruitment Documents System (HR CARDS) Survey	1	HRCARD Survey Questions
Influenza Vaccine Survey	1	2016 Flu Survey
Information Management Team (IMT) Web Intercept Survey	1	IMT Intercept survey Form
IntraHR Website Customer Satisfaction Survey	1	IntraHR Customer Satisfaction Survey
KAI Annual Client Satisfaction Survey	1	KAI Annual Client Survey Printscreens
LIS User Survey of NLM Resources	1	NLM LIS User Survey Instrument
LRP Ambassador Feedback	1	LRP Ambassador Feedback
LRP Qualitative Research	1	LRP Qualitative Research
Medical Arts Branch (MAB) Services Survey	1	Medical Arts Branch Survey
Medicine: Mind the Gap NIH Seminar Series Survey-For Profits	1	Customer Satisfaction Survey
Medicine: Mind the Gap NIH Seminar Series Survey-Not-For-Profits	1	Customer Satisfaction Survey
Medicine: NIH Mind the Gap Webinar Series Survey II	1	MtG Customer Satisfaction Survey - survey Monkey Screnshot
NCBI 2017 Sequence Database User Survey	1	NCBI Sequence Database User Survey
NCBI 2017 Website User Survey	1	NCBI 2017 Website User Survey Instrument
NCBI 2018 Genetics and Population Frequency Data Survey (NLM)	1	NCBI 2018 Genetics and Population Frequency Data instrument
NCBI BLAST Web Services 2017 Survey	1	NCBI BLAST Web Services 2017 Survey Instrument
NCBI Medical Genetics and Variation Web Resources 2017 Survey	1	NCBI Medical Genetics 2017 Survey Instrument
NCCIH Customer Service Data Collection	2, 1	Telephone Survey ,   Email Survey
NCI OFSM Relocation Survey - Office	1	NCI OFSM Relocation Survey - Office Moves
NCI OSFM Conference Room Services Survey	1	Survey
NCI OSFM Express Services Survey	1	Express Services Survey
NCI OSFM Fitness Center Survey	1	NCI OSFM Fitness Survey
NCI OSFM Relocation Survey- Lab	1	Lab Relocation
NCI OSFM Shuttle Service Survey	1	NCI OSFM Shuttle Service Survey Instrument
NCI OSFM Small Little Job (SLJ) Survey	1	Survey
NEI Health Focus Groups with New Audiences Ages 25-35	1, 2	NEI Screener ,   NEI Mod Guide
NHLBI's Health Information Center (HIC)	1, 2	Survey Instrument IVR ,   Survey Instrument Web Questions
NIH Events Management – Audio Visual Survey	1	FY 17 EM Audio Visual Survey
NIH Events Management – Post Production Survey	1	FY17 EM Post Production Survey
NIH Events Management – Scheduling Services Survey	1	FY17 EM Scheduling Services Survey
NIH Events Management – Video Production Survey	1	FY17 EM Video Production Survey
NIH Library Customer Satisfaction Survey	1	Desk Survey May 2018
NIH Library Survey on Statistical Class Offerings	1	NIH Stats Survey 2017
NIH Library Survey: Weekend Library Use	1	Weekend Use Nov 2017 Survey
NIH Native American Visit Week Feedback	1	Survey Instrument
NIH Office of Intramural Training & Education (OITE) – Community College Day Feedback	1	OITE-OMBFT- Community College Day- Feedback Collection
NIH Office of Intramural Training & Education (OITE) – General Feedback Form	2, 1	FEEDBACK ON AN OITE EVENT ,   CAREER SERVICES CENTER
NIH Office of Intramural Training & Education (OITE) – Graduate & Professional School Fair Feedback	1	Graduate and Professional School Fair Feedback Collection
NIH Office of Intramural Training & Education (OITE) – Management Boot Camp Feedback	1	MANAGEMENT BOOT CAMP FEEDBACK Form
NIH Research Training Institutes (RTIs) Customer Satisfaction Surveys	1, 2, 3	Applicants Survey ,   Faculty Survey ,   Trainee Survey
NIH Training Center Meeting Facilitation Survey	1	NIHTC Training Evaluation- Meeting Facilitation
NIMH Information Resource Center (IRC) Customer Satisfaction Surveys for Email Information Services, Online Publications Ordering Services and Telephone Services	1, 3, 2	Email services survey ,   Online publications ordering services survey ,   Telephone services survey
NIMH Professional Coalition for Research Progress Meeting Assessment Form	1	Professional Coalition for Research Progress Meeting Assessment form
NIMH Website Survey	1	NIMH Website Survey
NLM 2018 Public Libraries Association Survey	1	NLM 2018 Public Libraries urvey
NLM 4 Caregivers User Survey	1	NLM 4 Caregivers 2016 User Survey Instrument
NLM AIDSource 2017 Survey	1	NLM AIDSource 2017 Survey
NLM ClinVar 2016 User Survey	1	NLM ClinVar 2016 User Survey Instrument
NLM ClinVar 2017 Website User Survey	1	NLM NCBI ClinVar 2017 Survey Instrument
NLM Customer Service Satisfaction Survey	1	Survey Instrument
NLM DOCLINE Customer Service Survey	1	NLM DOCLINE Customer Service Survey Instrument
NLM GHR User Study Screening Survey	1	NLM GHR User Study Screening Survey Instrument
NLM Genetic Home Reference User Study	1	NLM GHR Use Study Interview Instrument
NLM Google Survey for MedlinePlus Page Satisfaction Rating	1	NLM MedlinePlus Google Survey Instrument
NLM Library Operations Customer Satisfaction Survey	1	NLM LO Customer Service Survey Instrument
NLM Main Website Satisfaction Survey	1	NLM Main Website Satisfaction Survey Instrument
NLM MedlinePlus Connect Customer Survey	1	Survey
NLM MedlinePlus Page Google Survey Satisfaction Rating	1	NLM MedlinePlus Google Survey Instrument (screenshots)
NLM MedlinePlus RML User Survey	1	NLM Medline Plus RML User Survey Instrument
NLM MedlinePlus Website Usability Testing	1	NLM MedlinePlus Usability Testing ICR Instrument
NLM NCBI 2018 Literature Resources Survey	1	NCBI 2018 Literature Resources Survey
NLM NCBI 2018 Representative Genomes Survey	1	NCBI 2018 Representative Genomes survey instrument
NLM NCBI CCDS User Survey	1	NLM NCBI CDDS Survey Instrument
NLM NCBI ClinicalTrials.gov Website Usability Survey 2017	1	NLM NCBI CT Usability Survey
NLM NCBI ClinicalTrials.gov Website User Survey	1	NLM NCBI CT.gov Website User Survey Instrument
NLM NCBI GRC Website User Survey	1	NLM NCBI GRC Website User Survey Instrument
NLM NCBI Gene Resources Website Survey	1	NLM NCBI Gene Resources Website User Survey Instrument
NLM NCBI Health Resources Survey	1	NLM NCBI Health Resource Survey screenshots
NLM NCBI Microbe Conference Survey	1	NLM NCBI Microbe Conference Survey Instrument
NLM Project SHARE website assessment	1	Focus Group Questions
NLM Reading Rooms Satisfaction Survey	2, 1	Survey Screenshots ,   Survey (paper version)
NLM Survey for MedlinePlus Page Satisfaction	1	NLM MedlinePlus Survey Instrument
NLM TOXNET 2018 Workshop Survey	1	NLM Toxnet 2018 Workshop Survey Instrument
NLM ToxTutor User Survey	1	NLM ToxTutor User Survey Instrument
NLM Traveling Exhibition Visitor Study	1	NLM Traveling Exhibition Visitor Survey
NLM Website Survey for Website Satisfaction Rating	1	NLM Websites Survey
National Institute of Dental and Craniofacial Research (NIDCR) Website Usability Study	1	Usability Test Questions
National Institute of Dental and Craniofacial Research Focus Group Study	2, 1	NIDCR-FG Moderator Guide ,   NIDCR Focus Group Recruitment Screener
National Institute of Mental Health (NIMH) Employee Engagement Survey	1	NIMH Employee Engangement Survey
National Institute of Mental Health (NIMH) Office of the Director and Extramural Programs Workforce Resource Analysis	1, 1	EX Workforace Analysis Focus Group Discussion Guide ,   EX Workforace Analysis Discussion Guide
ODP Pathways to Prevention Survey -For Profits	1	Survey Screenshot
ODP Pathways to Prevention Survey -Not For Profits	1	Survey Screenshot
ODP Pathways to Prevention Survey II	1	Obesity Methods P2P Survey
OER Intercept survey	1	OER Intercept Survey questions
OHR Website Customer Satisfaction Survey	1	OHR Website survey
OM All Hands Meeting Survey	1	OM All Hands Survey
ORF Workplace Aesthetic Survey (OD)	1	NIH Rockledge Visual Vocabulary Survey
Office of Human Resources (OHR) Climate Survey	1	2017 OHR Climate Survey
Office of Human Resources (OHR) Pulse Survey	1	OHR Pulse Survey
Office of Human Resources (OHR) Training Survey	1	HR Training Survey
Ombudsman Services Feedback Survey	1	NIH OOCCR Feedback Survey
Online Customer Service Survey About The Application Technical Assistance Webinar	1	LRP Webinar Survey
Outcomes of IDeA Core Optimization Administrative Supplements	1	NIGMS CRCB IDeA Core Supplement Follow-up Questions
Participant Feedback on 2016 NIH Common Fund High-Risk, High-Reward Research Symposium	1	Survey 2016 HRHR Symposium screenshot
Participant Feedback on 2017 NIH Common Fund 2017 Stimulating Peripheral Activity to Relieve Conditions (SPARC) Research Program Annual Awardee Meeting	1	Survey screenshot
Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Federal Government)	1	PEPH Aware-Act-Use
Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Private Sector)	1	PEPH Aware-Act-Use Survey
Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (State, Local or Tribal)	1	PEP Aware-Act-Use survey
Partnerships for Environmental Public Health Program (PEPH) Aware-Act-Use Survey (Individuals/households)	1	PEPH Aware-Act-Use instrument
Pathways for Teamwork Customer Satisfaction Interviews	1	Needs Analysis Interview Protocol
Patient Perception Survey (CC)	2, 1	NIHAIP Survey Mock-up - NRC Health ,   NIHAOP Survey Mock-up - NRC Health
Pediatric Patient Perception Survey (CC)	1	NRC NIH IP P Survey
Pragmatic & Group-Randomized Trials (GRT) in Public Health & Medicine Participant Feedback Survey: Parts 1-7	1	MOOC Survey
PubMed Search User Survey	1	NLM PubMed Search User Survey
Qualitative Research to Explore Barriers and Facilitators for LRP Ambassadors to Promote the NIH Loan Repayment Programs	1	Key Informant Interview Guide
Shuttle Bus Survey for Fishers Lane	1	OAS Shuttle Survey Screenshots
The Annual NIH Pain Consortium Symposium Feedback (For Profit)	1	Pain Survey
The Annual NIH Pain Consortium Symposium Feedback (Not For Profit)	1	Pain Survey
The NIH Director's Blog Readership Survey	1	NIH Blog Survey
The NIH Director's Blog Readership Survey	1	Survey
The NIH Extramural Loan Repayment Programs: Online Customer Service Survey About the Application Technical Assistance Webinar	1	FY2018 LRP Webinar Survey
The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form A	1	LRP Survey for Applicants Form A- Screenshots
The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form B	1	LRP Survey for Applicants Form B- Screenshot
The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form C	1	LRP Survey for Applicants Form C-Screenshots
The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Award Applicants	1	LRP Survey for Mentors-Screenshots 2
The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Institutional Business Officials (IBOs)	1	LRP IBO Survey- Screenshots
The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Mentors	1	LRP Survey for Mentors- Screenshots
The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Recommenders/Referees	1	LRP Referee Survey- Screenshots
Traveling Exhibition Host Survey	1	Host Survey
US-Japan Cooperative Medical Sciences Program (USJCMSP) 50th Anniversay and 18th International Conference on Emerging Infectious Diseases in the Pacific Rim	1, 2	USJCP Meeting screenshots ,   USJCP Meeting feedback form
Usability testing for PHPartners.org website	1	Survey Screenshot
Variation Resources Survey	1	NLM Variation Resources User Survey
WiTS Climate Survey 2015	1	2015 WiTS Climate Survey
Workflow Information Tracking System (WiTS) Focus Groups	1	WiTS Focus Group instrument
Workflow information Tracking System (WiTS) Focus Groups (OD)	1	WiTS Focus Group
Workplace and Organizational Performance Survey	1	Workplace Organizational Performance Survey
Workstyle Survey	1	Qualtrics Print

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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	759,000	759,000	0	0	0	0
Annual Time Burden (Hours)	148,074	148,074	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: $350,000

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: 01/29/2015

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