Memo

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0990-0459)

TITLE OF INFORMATION COLLECTION: Adolescent Health: Think. Act. Grow (TAG): Playbook Survey

PURPOSE:

In 2014, the Office of Adolescent Health launched Adolescent Health: Think, Act, Grow^® (TAG). TAG calls upon organizations and individuals to prioritize activities that can support the health and healthy development of all of America's 42 million adolescents. Since its launch, OAH has developed a number of products to implement and disseminate TAG. OAH would like to solicit feedback from users of TAG to assess their satisfaction and find areas for improvement.

DESCRIPTION OF RESPONDENTS:

Respondents will be those who have used, ordered, or downloaded TAG-related product(s), including individuals who are:

• health care professionals

• public health professionals

• out-of-school and community-based program professionals

• education professionals

• faith-based community professionals

• social services professionals

• workforce development professionals

TYPE OF COLLECTION:

[ ] 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: Emily Novick (Project manager’s name)

To assist review, please provide answers to the following questions:

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 [ X ] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ X ] No

Gifts or Payments:

Is an incentive (e.g., money, reimbursement of expenses or token of appreciation) provided to participants? [ ] Yes [X ] No If Yes, please describe the incentive and provide a justification for the amount.

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time (minutes)	Burden (hours)
TAG Playbook on-line survey used by these professionals: Health care, public health, education, faith-based community, social services, and workforce development	24,473	15	6,118
Totals	24,473		6,118

FEDERAL COST: The estimated annual cost to the federal government is $2,000.00

(Note: Amount should include contractor costs if the contractor is involved in the survey/collection)

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)?

OAH maintains an Excel spreadsheet with contact information from 140 individuals representing organizations who ordered TAG Playbooks. This Excel file contains the following information for those who have ordered Playbooks: name, email, organization, title/position, street address, phone number, and number of playbooks ordered. The research team will use the email addresses from this list to send emails inviting individuals to participate in the TAG online survey (see “Email Invitation to Participate in the TAG Online Survey”).

Once invited to the survey, the 140 individuals will then be asked to forward their invitation to those who received TAG Playbooks from them and to invite recipients of TAG playbooks to also participate in the TAG online survey (see “Email Invitation to Participate in the TAG Online Survey”). Over 24,000 Playbooks have been ordered to date. The research team estimates that approximately two percent of these recipients will respond to the survey request, which would provide an additional 500 survey responses.

In addition, OAH also maintains a list of contact information from conference attendees who signed up to receive emails from OAH. The conference list includes the following information: name and email address. Fifty-two people are on this list. The research team will use the email addresses from this list to also send emails inviting individuals to participate in the TAG online survey (see “Email Invitation to Participate in the TAG Online Survey”). Once invited to the survey, the 52 individuals will then be asked to forward their invitation to those who received TAG Playbooks from them and to invite recipients of TAG playbooks to also participate in the TAG online survey (see “Email Invitation to Participate in the TAG Online Survey”).

After clicking the link to take the survey, individuals will be taken to a website to provide their consent to participate in the study (see “Landing Page for the TAG Online Survey”). If individuals do not consent to participate in the study, they will be directed to a thank you message (see “Thank you Message (no consent)”).

If individuals do consent to participate in the study, they will be directed to the online survey (see attached “TAG Online Survey”). After completing and submitting the online survey, individuals will be directed to an online webpage thanking them for their time (see “Thank you Message Post-Survey”).

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?

Administration of the Survey

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 survey materials, instructions

and scripts are submitted with the request.