Fast Track Template DMID Order-It (FTE)

Fast Track Template 2017 DMID Order-It FTE (002).doc

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

Fast Track Template DMID Order-It (FTE)

OMB: 0925-0668

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Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0925-0668, Exp. date: 02/28/2019)

T ITLE OF INFORMATION COLLECTION: DMID Order-It Customer Satisfaction Survey


PURPOSE:

The Division of Microbiology and Infectious Diseases (DMID) within the National Institute of Allergy and Infectious Diseases (NIAID) supports extramural research to control and prevent diseases caused by virtually all human infectious agents except HIV. DMID provides funding opportunities and a comprehensive set of resources for researchers that support basic research, preclinical development, and clinical evaluation.

The DMID Order-It system is used by DMID’s clinical sites to order study product.  The system supports and furthers important clinical activity that falls within the scope of DMID’s mission. DMID hopes to obtain constructive feedback on how well, or not well, the system is working, and suggested ways for improvement. The program has not been reviewed in the 8 years since its inception. Feedback from the program’s users will help improve the application.


DESCRIPTION OF RESPONDENTS:


Users of the DMID Order-It system, both federal and non-federal.


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:______Jae Arega ORA/DMID/NIAID____________________________________


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 [ 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

Federal employee

63

1

10/60

11

Totals

63

63


11



Category of Respondent


Total Burden

Hours

Hourly Wage Rate*

Total Burden Cost

Federal employee

11

$40.24

$442.64

Totals

11


$449.02

*Federal Executive Branch Median Salary - https://www.bls.gov/oes/2017/May/naics4_999100.htm


FEDERAL COST: The estimated annual cost to the Federal government is $7293


Staff


Grade/Step

Salary

% of Effort

Fringe (if applicable)

Total Cost to Gov’t

Federal Oversight






Deputy Director/ORA

15/6

$157,253

0.1


$1573













Contractor Cost


$5720



$5720







Travel






Other Cost












Total





$7293




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?


We will use an existing list of system users.



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

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

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




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File Typeapplication/msword
File TitleGeneric Clearance Submission Template
SubjectGeneric Clearance Submission Template
AuthorOD/USER
Last Modified BySYSTEM
File Modified2018-09-13
File Created2018-09-13

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