Fast Track Submission Form

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0925-0648 ExpDate:03/31/2018)

T ITLE OF INFORMATION COLLECTION: NCCIH Customer Service Data Collection

PURPOSE: NCCIH (formerly NCCAM) provides the public, patients, families, health care providers, complementary health practitioners, and others with the latest scientifically based information on complementary health approaches and information about NCCIH’s programs through a variety of channels, including its toll-free telephone information service and email correspondence service. NCCIH wishes to continue to measure customer satisfaction with NCCIH telephone and email interactions and to assess which audiences are being reached through these channels. This effort involves a telephone survey and an email survey. The telephone survey consists of 10 questions, which 25 percent of all callers are asked to answer, for an annual total of approximately 270 respondents. The email survey consists of seven questions, which will be included with responses to each email inquiry received, for an annual total of approximately 142 respondents. The respondents’ data will be protected to the extent allowed by law. NCCIH uses the data collected from the survey to help program staff measure the impact of their communication efforts, tailor services to the public and health care providers, measure service use among special populations, and assess the most effective media and messages to reach these audiences.

DESCRIPTION OF RESPONDENTS: Respondents are patients, spouses/family/friends of patients, health care providers, physicians, complementary health practitioners, or other individuals contacting the NCCIH Clearinghouse.

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:__Shawn K. Stout________________________________________

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

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ X ] Yes [ ] 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? [ ] 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
Individuals or households (telephone survey)	270	10	5/60	23
Individuals or households (email survey)	142	7	3/60	7
Totals	412	17	8/60	30

Category of Respondent	Total Burden Hours	Hourly Wage Rate*	Total Burden Cost
Individuals or households (telephone survey)	23	$24.50	$563.50
Individuals or households (email survey)	7	$24.50	$171.50
Totals			$735

*Cite source per bls.gov if applicable

BLS Management, Professional, and Related Occupations

http://www.bls.gov/cps/cpsaat39.htm

FEDERAL COST: The estimated annual cost to the Federal government is $3,184.50

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight	GS-13/6	$85,300	0.5%		$426.50
Contractor Cost		$98,500	2.8	NA	$2,758.00
Travel					NA
Other Cost					NA

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?

Respondent Universe and Sampling Methods

The population for the telephone survey consists of callers to the NCCIH telephone information service. Based on summary statistics for April 2014 to March 2015, an average of 165 callers per month telephoned the NCCIH telephone information service. The projected annual number of callers is 1,960. NCCIH is interested in continuing to ascertain how callers learned of the NCCIH telephone information service and how satisfied callers are with the information provided. In order to meet the needs of the diverse population of callers, NCCIH would like to assess both of these topics by distinct user types (user types of interest are listed in Table A below). These user types are expected to have different needs and expectations regarding information obtained from NCCIH.

The population for the email survey consists of inquirers who email the NCCIH information service. Based on summary statistics for April 2014 to March 2015, an average of 120 inquirers per month emailed the NCCIH information service. The projected annual number of email inquiries received is 1,420. NCCIH is interested in continuing to ascertain how inquirers learned of the NCCIH information service and how satisfied inquirers are with the information provided. In order to meet the needs of the diverse population of inquirers by email, NCCIH would like to assess both of these topics by distinct user types (user types are listed in Table B below). These user types are expected to have different needs and expectations regarding information obtained from NCCIH.

Estimated annual population counts for these user types, based on survey results to date, are shown in the table below. It is estimated that nearly 8 of every 10 callers (76 percent) fall into one of three groups: patient, spouse/relative/friend of patient, and general public. Other callers, such as complementary health practitioners, other health care providers, and researchers, acquire information for professional use.

Table A. Population of Callers to NCCIH Telephone Information Service
User type	Annual estimated callers
	Number	Percentage
Patient	690	35%
Spouse/relative/friend of patient	350	18%
General public	450	23%
CH practitioner	50	3%
Other health care provider	70	4%
Researcher or grant applicant	70	4%
Journalist/media professional	10	1%
Student	70	4%
Other	150	8%
TOTAL	1,960	100

An approximate 25 percent sampling rate (actually 23 percent) of callers is utilized, yielding a starting sample size of 490 callers. Assuming a gross response rate of 55 percent based on survey results to date, the actual number of callers participating in the interview is estimated to be 270.

Estimated annual population counts for these user types, based on survey results to date, are shown in the table below. It is estimated that nearly 4 of every 10 inquirers (38 percent) fall into one of three groups: patient, spouse/relative/friend of patient, and general public. Other inquirers, such as complementary health practitioners, other health care providers, and researchers, acquire information for professional use.

Table B. Population of Inquirers to NCCIH Email Information Service
User type	Annual estimated inquirers
	Number	Percentage
Patient	100	7%
Spouse/relative/friend of patient	50	4%
General public	380	27%
CH practitioner	110	8%
Other health care provider	130	9%
Researcher or grant applicant	150	11%
Journalist/media professional	40	3%
Student	110	8%
Other	350	25%
TOTAL	1,420	100

The survey will be sent with responses to each email inquiry received in English, which is to approximately 1,420 inquirers per annum. Assuming a gross response rate of 10 percent based on results of a similar survey for NCCIH’s email-based newsletter, the actual number of inquirers participating in the survey is estimated to be 142.

Administration of the Instrument

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

[ ] Web-based or other forms of Social Media

[ X ] Telephone

[ ] In-person

[ ] Mail

[ X ] Other, Explain: NCCIH wishes to continue to measure customer satisfaction with NCCIH telephone and email interactions and to assess which audiences are being reached through these channels.

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

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

Appendix A: Survey Instrument: Telephone Survey

Appendix B: Caller Anonymity

Appendix C: Survey Instrument: Email Survey

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