GenIC request

Request for Approval under the “Generic Clearance for the Collection of
Routine Customer Feedback” (OMB Control Number: 0923-0047)
TITLE OF INFORMATION COLLECTION: NCEH/ATSDR Wellness Needs Assessment
PURPOSE: The purpose of this information collection is to collect information from
NCEH/ATSDR staff on their current wellness practices, wellness-related interests, and wellness
needs. The data collected will be used to plan NCEH/ATSDR wellness activities and events for
the 2018 calendar year.
The NCEH/ATSDR Wellness Committee, in coordination with the Office of Safety, Security,
and Asset Management (OSSAM) WorkLife Wellness Office (WWO), works to improve
wellness through education and activities that support healthy lifestyles, resulting in improved
productivity and morale for the NCEH/ATSDR staff members. The mission of the
NCEH/ATSDR Wellness Committee is to collaborate with other CDC Wellness Partners in
promoting the health and wellness of employees and contractors, through education and
initiatives that will encourage habits of employee engagement and wellness, increase awareness
of factors and resources contributing to well-being, support a sense of community, and inspire
and empower individuals to take the responsibility for their own well-being.
The proposed information collection consists of a needs assessment (Attachment B1) designed to
address: 1) wellness topics and activities of importance to staff; 2) staff interest in proposed
future wellness activities; 3) wellness activities to boost employee morale; 4) optimal times to
schedule wellness activities and events; and 5) priority areas for staff. Collected information will
be essential in the planning of Center wellness activities and ensuring that NCEH/ATSDR staffs’
wellness needs are being addressed.
DESCRIPTION OF RESPONDENTS: The online survey questionnaire will be offered to all
federal employees, contractors and fellows within NCEH/ATSDR.
TYPE OF COLLECTION: (Check one)
[ ] Customer Comment Card/Complaint Form
[ ] Usability Testing (e.g., Website or Software)
[ ] Focus Group

[ ] Customer Satisfaction Survey
[ ] Small Discussion Group
[X ] Other: Needs assessment_____

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.

Padmaja Vempaty -S Date: 2018.04.12 14:56:00 -04'00'
Name:________________________________________________
Digitally signed by Padmaja Vempaty -S

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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

BURDEN HOURS
We expect an 80% response rate for the online survey questionnaire.
Category of Respondent

No. of
Participation
Respondents Time
100
15/60
100
15/60
200

Federal government employees
Contractors/Fellows
Totals

Burden
25
25
50

FEDERAL COST: The estimated annual cost to the Federal government is $240. This cost
reflects approximately 5 hours of salary for one GS-12, step 10 staff person to: 1) design and
implement the needs assessment; and 2) draft an internal report of results ($48 per hour x 5
hours, https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salarytables/pdf/2018/ATL_h.pdf) .
The annual cost associated with respondent burden hours is approximately $1656.50. The
annual cost is estimated using an average salary of $33.13 per hour for environmental specialists
(https://www.bls.gov/ooh/life-physical-and-social-science/environmental-scientists-andspecialists.htm).
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?
[ ] Yes [ X ] 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?

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The NCEH/ATSDR Office of Management and Analytics (OMA) will send an email
(Attachment A1) to all NCEH/ATSDR staff requesting that they complete the voluntary needs
assessment. The needs assessment will be open for a period of three weeks. A reminder email
(Attachment A2) will be sent one week before the close of the needs assessment.
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
SurveyMonkey® will be used to collect the online needs assessment responses. The use of
SurveyMonkey® has been reviewed and approved to be compliant with HHS IT security
standards. An IT security plan is in place for this application.
Please make sure that all instruments, instructions, and scripts are submitted with the
request.
The following attachments are included:
Attachment A1 – Needs Assessment Invitation Email
Attachment A2 – Needs Assessment Reminder Email
Attachment B1 – NCEH/ATSDR Wellness Needs Assessment (text)
Attachment B2 – NCEH/ATSDR Wellness Needs Assessment (screenshots)

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