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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Online Survey: Pediatric Palliative Care Provider Resources	Form	New	Available
Form 1 Individual interviews to solicit feedback on Spanish language family-focused materials developed for a pediatric palliative care communications campaign	Form and Instruction	New	Available
Form 1 Individual interviews to solicit feedback on family-focused materials developed for a pediatric palliative care communications campaign	Form and Instruction	New	Available
0925-0653-Extension_2-Substudy-Approvals.docx	Supplementary Document	Uploaded 2015-03-16	Available
0925-0653-Extension_1-Substudy-Template.doc	Supplementary Document	Uploaded 2015-03-16	Available
0925-0653-Extension_SSB.doc	Supporting Statement B	Uploaded 2015-03-16	Available
0925-0653-Extension_SSA.docx	Supporting Statement A	Uploaded 2015-03-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
227193	Online Survey: Pediatric Palliative Care Provider Resources	Form	New
219062	Individual interviews to solicit feedback on Spanish language family-focused materials developed for a pediatric palliative care communications campaign	Form and Instruction	New
218085	Individual interviews to solicit feedback on family-focused materials developed for a pediatric palliative care communications campaign	Form and Instruction	New

ICR Details

OMB Control No: 0925-0653	ICR Reference No: 201503-0925-004
Status: Historical Active	Previous ICR Reference No: 201202-0925-003
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NINR)
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: 04/30/2015
	Date Received in OIRA: 03/30/2015
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2018	36 Months From Approved	04/30/2015
Responses	4,425	0	4,425
Time Burden (Hours)	3,075	0	3,075
Cost Burden (Dollars)	0	0	0

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Abstract: This is an extension to the previously approved submission (0925-0653). There are no changes being requested for this submission. The information collection activity has garnered qualitative customer and stakeholder feedback in an efficient, timely manner, in accordance with the Administration's commitment to improving service delivery. This generic has provided information about the National Institute of Nursing Research's (NINR) customer or stakeholder perceptions, experiences and expectations, provide an early warning of issues with service, or focus attention on areas where communication, training or changes in operations might improve delivery of products or services. It has also allowed feedback to contribute directly to the improvement of program management. Feedback collected under this generic clearance provides useful information but it does not yield data that can be generalized to the overall population.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Customer Satisfaction
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 249	12/30/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 15799	03/25/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Individual interviews to solicit feedback on Spanish language family-focused materials developed for a pediatric palliative care communications campaign	1, 2	Appendic C Interview Script and Questions ,   Appendix A RecruitmentPlan&ScreenerSPA
Online Survey: Pediatric Palliative Care Provider Resources	1	Appendix A Provider Survey
Individual interviews to solicit feedback on family-focused materials developed for a pediatric palliative care communications campaign	2, 1	Appendix A InterviewRecruitment ,   Appendix C InterviewInstrument

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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	4,425	4,425	0	0	0	0
Annual Time Burden (Hours)	3,075	3,075	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: $104,425

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: 03/30/2015

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