Fast Track PRA Submission Short Form

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Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0990-0379)
TITLE OF INFORMATION COLLECTION:  
HRSA/National Health Service Corps (NHSC) Information Architecture Validation

PURPOSE:  The goal of this study is to validate proposed updates to the information architecture of the National Health Service Corps (NHSC) website. The NHSC website revamp effort is one component of an agency-wide effort intended to make content on all HRSA web sites more streamlined, targeted, actionable, and aligned with the organization’s strategic goals. To this end, the tree test study will validate that the architecture, labels and content hierarchy of the redesigned NHSC site facilitates the completion of tasks that users of this site find critical to their work.


DESCRIPTION OF RESPONDENTS: 
Subscribers to the National Health Service Corps’ online newsletters, loan/scholarship recipients, and website visitors.



TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form 	[ ] Customer Satisfaction Survey    
[X] 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:_ __Christy Choi_____

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, will any information that is collected be included in records that are subject to the Privacy Act of 1974?   [  ] Yes [ ] No   
    3. If Yes, has an up-to-date System of Records Notice (SORN) 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  


BURDEN HOURS 

Category of Respondent 
No. of Respondents
Participation Time
Burden
Individuals: Students, researchers, advocates, health/social service professionals
300
10 minutes
50 hours
State/Local/Tribal Government: State/Local health workforce office staff
50
10 minutes
8.3 hours
Totals
350
10 minutes
59 hours

FEDERAL COST:  
The estimated annual cost to the federal government is $3,300.00 which includes 1) $2,500              instrument development, fielding, and analysis, 2) $600 (12.5 hours at the GS-13 level) in project management and oversight, and 3) $200.00 in hosting charges from OptimalWorkshop.com

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?

A general bulletin announcing the study will be issued by the administrators of HRSA’s GovDelivery system. The bulletin will contain a link to the study. Clicking the link will assign a random number to the study responses as the only identifier of the respondent. After the full complement of responses is collected, survey responses will be screened to remove surveys less than 75% complete.






Administration of the Instrument
    1. How will you collect the information? (Check all that apply)
[X] Web-based or other forms of Social Media 
[  ] Telephone	
[  ] In-person	
[  ] Mail 
[  ] Other, Explain
    2. Will interviewers or facilitators be used?  [  ] Yes [X] No
 
Please make sure that all instruments, instructions, and scripts are submitted with the request.
Instructions for completing Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” 

TITLE OF INFORMATION COLLECTION:  Provide the name of the collection that is the subject of the request. (e.g.  Comment card for soliciting feedback on xxxx)

PURPOSE:  Provide a brief description of the purpose of this collection and how it will be used.  If this is part of a larger study or effort, please include this in your explanation.

DESCRIPTION OF RESPONDENTS: Provide a brief description of the targeted group or groups for this collection of information.  These groups must have experience with the program.

TYPE OF COLLECTION: Check one box.  If you are requesting approval of other instruments under the generic, you must complete a form for each instrument.

CERTIFICATION:  Please read the certification carefully.  If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.

Personally Identifiable Information:  Provide answers to the questions.  Note:  Agencies should only collect PII to the extent necessary, and they should only retain PII for the period of time that is necessary to achieve a specific objective.

Gifts or Payments:  If you answer yes to the question, please describe the incentive and provide a justification for the amount.

BURDEN HOURS:
Category of Respondents:  Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households; (2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government.  Only one type of respondent can be selected per row. 
No. of Respondents:  Provide an estimate of the Number of Respondents.
Participation Time:  Provide an estimate of the amount of time (in minutes) required for a respondent to participate (e.g. fill out a survey or participate in a focus group)
Burden:  Provide the Annual burden hours: Multiply the Number of Respondents and the Participation Time then divide by 60.

FEDERAL COST: Provide an estimate of the annual cost to the Federal government.

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.  Please provide a description of how you plan to identify your potential group of respondents and how you will select them.  If the answer is yes, to the first question, you may provide the sampling plan in an attachment.

Administration of the Instrument:  Identify how the information will be collected.  More than one box may be checked.  Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.

Submit all instruments, instructions, and scripts with the request.