NICHD DASH 2018 Individual fast track template

Request for Approval under the “Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NICHD)”

(OMB#: 0925-0643 ExpDate:2/28/2021)

TITLE OF INFORMATION COLLECTION: NICHD DASH -Study Request and/or Study Submission Survey.

PURPOSE: The purpose of these surveys is to solicit feedback on the study request and study submission user friendliness, efficiency of workflow, and process with the ultimate goal of improving the overall experience of using NICHD DASH. The survey will be delivered after the DASH registered user has completed and obtain approval of the data submission or data request. The DASH registered user will receive an approval notification email containing a link to the respective survey.

DESCRIPTION OF RESPONDENTS: The respondents will be DASH registered users who have either submitted study data or requested study data in NICHD DASH. The registered users have used the NICHD DASH interface and can vary from academic, government, nonprofit or for-profit principal investigators and, also, include graduate students, medical students, and medical fellows.

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: Susan Tenney

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 [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 or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X] No

ESTIMATED BURDEN HOURS and COSTS

Form Name	Category of Respondents	Number of Respondents	Number of Responses per Respondent	Average Burden Per Response (in hours)	Total Annual Burden Hours
NICHD DASH-Study Requester Survey	Individuals	49	1	5/60	4
NICHD DASH-Study Submitter Survey	Individuals	5	1	10/60	1
Total		54	54		5

Category of Respondents	Total Burden Hours	Wage Rate*	Total Burden Cost
Individuals	5	$45.64	$228.20
Totals			$228.20

Salary/Wage Source: Bureau of Labor Statistics/Occupational Employment and Wages, May 2017: Occupational Code 19-1042, Medical Scientists, national estimates: https://www.bls.gov/oes/current/oes191042.htm

FEDERAL COST: The estimated annual cost to the Federal government is $3,826.05

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Application Lead/ Program Officer	GS-15/ Step 4	$ 144,945	1.0		$1,449.45
Contractor Cost
Archive Administrator/ Content Analyst		$ 118,830	2.0		$2,376.60
Total					$3,826.05

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?

The customer list is composed of all the registered users in NICHD DASH. Surveys will only be sent to those registered users who have requested or submitted data and have received approval through NICHD DASH.

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

4