Fast-Track Template

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

TITLE OF INFORMATION COLLECTION: NLM Project SHARE website assessment

PURPOSE: Project SHARE website hosts an online health information literacy curriculum for adolescents. The site was sponsored by the NLM Division of Specialized Information Services and developed by University of Maryland Health Sciences and Human Services Library. The goal of this information collection using focus groups is to assess customer satisfaction with the site and for the health literacy education program built around the website. The results will be used to inform improvement of Project SHARE materials.

DESCRIPTION OF RESPONDENTS: Respondents are middle and high school students in grades 7-12, currently enrolled in a semester-long health literacy education program that uses Project SHARE online materials. Each site enrolls 10-14 participants. All participants at each site will be invited to participate.

TYPE OF COLLECTION: (Check one)

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

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

[X] 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: Alla Keselman_______________________

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
Individuals or households	72	1	1	72 hrs.
Total	72	72		72 hrs.

Category of Respondent	Total Burden Hours	Wage Rate*	Total Burden Cost
Individuals or households	72 hrs.	N/A *	$ 0.00
Total			$ 0.00

*Middle and highs school students (not employed with a wage rate)

FEDERAL COST: The estimated annual cost to the Federal government is: $1,745.85

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight	GS-14/8	$134,296	1.3		$1,745.85
Contractor Cost					N/A
Travel					N/A
Other Cost					N/A
Total					$1,745.85

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

The universe of potential respondents includes 72 students enrolled in the NAO health literacy education program across its six sites. While participation is voluntary, we hope that all students will choose to participate.

Administration of the Instrument

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

[ ] Web-based or other forms of Social Media

[ ] Telephone

[X] In-person

[ ] Mail

[X] Other: All focus groups will be conducted by Dr. Alla Keselman from the Division of Specialized Information Services, NLM. At sites located within reasonable geographic distance from the NLM, Dr. Keselman will mediate focus groups in person. Where travel is not feasible, focus groups will be facilitated via video-conferencing software.

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

All focus groups will be conducted by Dr. Alla Keselman from the Division of Specialized Information Services, NLM. Participant’s names and other personally identifying information will not be collected.

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

Attachment 1: NLM Project SHARE Focus Group Questions

Attachment 2: NLM Project SHARE Participant consent form

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