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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 BYOMM KAB	Form and Instruction	New	Available
Form 1 Literature Survey	Form and Instruction	New	Available
Form 1 NCBI IPG survey	Form and Instruction	New	Available
Form 1 ONSEN survey	Form and Instruction	New	Available
Form 1 KOliver Screenshots	Form and Instruction	New	Available
Form 2 Physicians Moderator Guide	Form and Instruction	New	Available
Form 1 Navigator Screener Round 2	Form and Instruction	New	Available
Form 1 NCBI 2019 Genome Survey	Form and Instruction	New	Available
Form 1 Assist User Experience	Form and Instruction	New	Available
Form 1 HRHR Symposium Satisfaction Survey	Form	New	Available
Form 1 Survey	Form	New	Available
Form 3 Evaluation Day 3 screenshot	Form and Instruction	New	Available
Form 2 Evaluation Day 2 screenshot	Form and Instruction	New	Available
Form 1 Evaluation Day 1 screenshot	Form and Instruction	New	Available
Form 1 OITBrownBag survey	Form	New	Available
Form 1 2019 Nonprofit Forum on-site meeting feedback survey	Form and Instruction	New	Available
Form 1 DOHS survey screenshot	Form and Instruction	New	Available
Form 1 NIAAA Website Survey Screenshot	Form and Instruction	New	Available
Form 1 DOCLINE Survey instrument	Form	New	Available
Form 1 GHR Survey Instrument	Form	New	Available
Form 1 RML Family Care Survey Screenshot	Form and Instruction	New	Available
Form 2 Post-Presentation screenshot	Form and Instruction	New	Available
Form 1 Pre-Presentation Survey screenshot	Form and Instruction	New	Available
Form 1 NCBI Run Selector Survey Instrument	Form	New	Available
Form 1 TTIPO Fellowship Survey screenshots	Form	New	Available
Form 1 BRAIN PI Mtg - Event App Survey Screenshots	Form and Instruction	New	Available
Form 1 Post WorkshopEvaluation --US-KZ AMR 2019 screenshots	Form and Instruction	New	Available
Form 1 2019 ClinVar Survey	Form	New	Available
Form 1 Data Science Survey	Form and Instruction	New	Available
Form 1 NCBI BioProject BioSample Survey	Form	New	Available
Form 3 NCATS Toolkit RDD Test Plan	Form and Instruction	New	Available
Form 2 NCATS RaDaR RDD Test Plan	Form and Instruction	New	Available
Form 1 NCATS GARD RDD Test Plan	Form and Instruction	New	Available
Form 1 NLM 2019 CT Usability Survey	Form	New	Available
Form 1 DSTRP survey instrument	Form	New	Available
Form 1 Clinical trials website survey	Form	New	Available
Form 1 GDB screenhots	Form and Instruction	New	Available
Form 1 MedlinePlus Survey Instrument	Form	New	Available
Form 1 Statistics CS Survey	Form	New	Available
Form 1 PubMed User Survey Instrument	Form	New	Available
Form 1 CHEAR Client Satisfaction survey	Form	New	Available
Form 1 NCBI 2019 Protein Resource Survey	Form and Instruction	New	Available
Form 1 DIS Survey Instrument	Form and Instruction	New	Available
Form 1 ED DOHS OIIP Survey screenshot	Form and Instruction	New	Available
Form 1 NIMH OFT Annual Trainee Survey Questions	Form and Instruction	New	Available
Form 1 NLM Site-wide Survey for Website Satisfaction Rating 2019	Form	New	Available
Form 1 NLM Site-wide Survey for Website Satisfaction Rating 2019	Form and Instruction	New	Available
Form 1 NIAAA Author Feedback Call	Form and Instruction	New	Available
Form 1 NLM NCBI 2018 Population Frequency Data Survey	Form and Instruction	New	Available
Form 1 Equipment Survey	Form	New	Available
Form 1 CIT Customer Satisfaction Survey Form	Form	New	Available
Form 2 ODS Administrative Supplement survey	Form	New	Available
Form 1 ODS Scholars Feedback Survey	Form	New	Available
Form 1 Innovative Clinical Trials Resource (ICTR) screenshot	Form	New	Available
Form 1 NCBI 2018 Blast Survey	Form	New	Available
Form 1 Health Science Data Needs As survey instrument	Form	New	Available
Form 1 UMLS 2018 User Survey	Form and Instruction	New	Available
Form 1 ALivinski Library Survey Screenshots	Form	New	Available
Form 1 Survey	Form	New	Available
Form 1 Health Science Data Needs Assessment	Form and Instruction	New	Available
Form 1 P2P Post Survey Screenshots	Form	New	Available
Form 1 ChangeReadiness Survey screenshot	Form and Instruction	New	Available
Form 1 QFCSR Fall 2018	Form	New	Available
Form 1 FY2019 LRP Webinar Survey	Form	New	Available
Form 1 NCBI Submission Survey	Form	New	Available
Form 1 STEP UP survey screenshot	Form and Instruction	New	Available
Form 1 NLM Exhibition Program Portal Usability Study Instrument	Form	New	Available
Form 1 NLM Exhibition Program Portal Usability Study Instrument	Form	New	Available
Form 1 OMBFT-Amgen-Alumni-WhereAreYouNow	Form	New	Available
Form 1 Amgen Scholars Feedback survey	Form	New	Available
Form 1 NOVISurvey NINDS Publication Survey	Form	New	Available
Form 1 LD PRA Screenshots On the Move	Form	New	Available
Form 1 DSEIS PRA Screenshots	Form	New	Available
Form 1 Graphical Sequence Display Survey	Form	New	Available
Form 1 NIH Library Screenshot	Form	New	Available
Form 1 Cool Down Day BDS	Form and Instruction	New	Available
Form 1 NCBI 2018 Gene Resource Survey Instrument	Form	New	Available
Form 1 HRHR Symposium survey 2018	Form	New	Available
Form 1 NCBI 2018 PubChem Survey Instrument	Form	New	Available
Form 1 NIMH Core User Survey template	Form	New	Available
Form 1 PEPH Aware Act Use Survey	Form	New	Available
Form 1 PEPH Aware Act Use Survey	Form	New	Available
Form 1 PEPH Aware Act Use Survey	Form	New	Available
Form 1 PEPH Aware-Act-Use Survey	Form	New	Available
Form 1 2018 Train-the-Trainers- (Federal) Feedback form	Form	New	Available
Form 1 2018 Train-the-Trainers Feedback form	Form	New	Available
Form 1 GeneEd User Survey	Form	New	Available
Form 1 NCBI 2018 Transcript Resources Survey	Form	New	Available
Form 1 NLM HMD 2018 Traveling Exhibition Host Survey	Form	New	Available
Form 1 NCBI Microbial Genome Resources Survey	Form and Instruction	New	Available
Form 1 CSR New Chair Orientation	Form and Instruction	New	Available
Form 1 2018 OPP Mtg Assessment Form	Form	New	Available
Form 1 NLM Websites Survey	Form	New	Available
Form 1 BYOMM After Action	Form	New	Available
Form 1 User Survey Instrument NLM MedlinePlus Website	Form and Instruction	New	Available
Form 1 WiTS Focus Group Instrument	Form and Instruction	New	Available
Form 1 Survey Instrument	Form and Instruction	New	Available
Form 1 Survey Screenshots	Form and Instruction	New	Available
Form 1 Survey with Burden Disclosure Statement	Form and Instruction	New	Available
Form 1 PEPH Aware Act Use Survey	Form and Instruction	New	Available
Form 1 PEPH Aware Act Use Survey Final	Form and Instruction	New	Available
Form 1 PEPH Aware Act Use Survey	Form and Instruction	New	Available
Form 1 PEPH Aware Act Use Survey Final	Form and Instruction	New	Available
Form 1 NIMH Professional Coalition for Research Progress Meeting Assessment Form	Form and Instruction	New	Available
Form 2 Guide New Aud Attachment B	Form and Instruction	New	Available
Form 1 New Aud FG Attachment A Screnner	Form and Instruction	New	Available
Form 1 HMD 2018 Exhibition Web Usability Study Instrument	Form and Instruction	New	Available
Form 1 SIS Emerging Adults Focus Group Survey	Form and Instruction	New	Available
Form 1 NCBI ClinVar 2017 Survey instrument	Form	New	Available
Form 1 2018 Feedback Career Service Center	Form	New	Available
Form 1 NCBI 2018 Genetics and Population Frequency Data Survey	Form	New	Available
Form 1 2018 Public Libraries Survey instrument	Form and Instruction	New	Available
Form 1 NIDA- Website Feedback Survey Screenshots	Form and Instruction	New	Available
Form 1 NLM TOXNET 2018 Workshop Survey instrument	Form and Instruction	New	Available
Form 1 OHR Pulse Survey	Form and Instruction	New	Available
Form 1 NIH HRSS Customer Satisfaction Survey	Form and Instruction	New	Available
Form 1 DSSEM Application and Interview Survey	Form and Instruction	New	Available
Form 1 2017 OHR Climate Survey	Form and Instruction	New	Available
Form 1 P2P Survey Screenshots	Form and Instruction	New	Available
Form 1 2015 WiTS Climate Survey	Form and Instruction	New	Available
Form 1 Retiree Survey	Form and Instruction	New	Available
Form 1 MtG Customer Satisfaction Survey	Form	New	Available
Form 1 P2P Survey screenshots	Form	New	Available
Form 1 P2P Survey screenshots	Form	New	Available
Form 1 Survey/Monkey	Form	New	Available
Form 1 KAI Research Questions for NIAMS Customer Survey	Form	New	Repair queued
Form 1 NIMH Website Survey Screenshots	Form	New	Available
Form 3 Online Publication Ordering Survey	Form	New	Available
Form 2 Email Service survey	Form	New	Available
Form 1 Telephone Service Customer Satisfaction survey	Form	New	Available
Form 1 NCBI 2017 Website User Survey Instrument	Form and Instruction	New	Available
Form 1 NCBI 2018 Literature Resources Survey	Form and Instruction	New	Available
Form 1 NLM Traveling Exhibition Visitor Survey	Form and Instruction	New	Available
Form 1 NCBI 2018 Representative Genomes Survey	Form and Instruction	New	Available
Form 1 NLM Website Survey Instrument	Form and Instruction	New	Available
Form 1 NRC NIH Inpatient Pediatric Survey	Form	New	Available
Form 1 Patient Portal Online Survey Screenshot	Form	New	Available
Form 2 NIH Outpatient Mock-up -NRC Health	Form	New	Available
Form 1 NIH Inpatient Mock-up - NRC Health	Form	New	Available
Form 1 CHEAR Client Satisfaction Survey	Form	New	Available
Form 1 NAVisit week Collection	Form	New	Available
Form 1 Management Boot Camp form	Form	New	Available
Form 1 Graduate & Professional School Fair Feedback Collection	Form	New	Available
Form 2 General Feedback Collection form	Form	New	Available
Form 1 Community College Day feedback	Form	New	Available
Form 1 Career Symposium Collection Form	Form	New	Available
Form 1 Pain 2015 Survey Monkey	Form	New	Available
Form 1 NINDS Public Site Widget screenshot	Form	New	Available
2017 SSA Generic NIHWide Fast Track1 (2).docx	Supporting Statement A	Uploaded 2018-03-22	Available
30-day FRN2018-05172.pdf	Supplementary Document	Uploaded 2018-03-22	Available
Fast Track Template 2016.doc	Supplementary Document	Uploaded 2018-03-01	Available
2017 SSB_0925-0648_NIH Wide Fast Track Extension.docx	Supporting Statement B	Uploaded 2018-03-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
236608	Brother Your On My Mind (BYOMM) Knowledge Attitudes and Belief (KAB) (NIMHD)	Form and Instruction	New	BYOMM KAB
236606	Literature Search Customer Feedback Survey (NIH Library)	Form and Instruction	New	Literature Survey
236602	NCBI 2019 Identical Protein Groups (NLM)	Form and Instruction	New	NCBI IPG survey
236576	Soliciting Feedback on the Omics Nursing & Education Network (ONSEN) Website (NINR)	Form and Instruction	New	ONSEN survey
236484	SR Maximizing Value 3Month Post (ORS/OD)	Form and Instruction	New	KOliver Screenshots
236478	Focus Group for Primary Care Providers Regarding Alcohol Treatment (NIAAA)	Form and Instruction	New	Physicians Moderator Guide
236478	Focus Group for Primary Care Providers Regarding Alcohol Treatment (NIAAA)	Form and Instruction	New	Navigator Screener Round 2
236407	NCBI 2019 Genome Resource Survey (NLM)	Form and Instruction	New	NCBI 2019 Genome Survey
236365	Assist User Experience	Form and Instruction	New	Assist User Experience
236197	Feedback on NIH Common Fund's High Risk, High-Reward Research Symposium (OD)	Form	New	HRHR Symposium Satisfaction Survey
236037	Survey to Assess the Quality of Grant Review Among NIH Center for Scientific Review Reviewers (CSR)	Form	New	Survey
235845	Participant Feedback for the Mary Frances Picciano Dietary Supplement Research Practicum (DSRP) on May 29–31, 2019 at the Lister Hill Auditorium (NLM)	Form and Instruction	New	Evaluation Day 3 screenshot
235845	Participant Feedback for the Mary Frances Picciano Dietary Supplement Research Practicum (DSRP) on May 29–31, 2019 at the Lister Hill Auditorium (NLM)	Form and Instruction	New	Evaluation Day 2 screenshot
235845	Participant Feedback for the Mary Frances Picciano Dietary Supplement Research Practicum (DSRP) on May 29–31, 2019 at the Lister Hill Auditorium (NLM)	Form and Instruction	New	Evaluation Day 1 screenshot
235819	OIT Training Customer Satisfaction Survey (OD)	Form	New	OITBrownBag survey
235751	2019 Nonprofit Forum on-site meeting feedback (NINDS)	Form and Instruction	New	2019 Nonprofit Forum on-site meeting feedback survey
235750	Soliciting Feedback About the National Institutes of Health (NIH) Office of the Director (OD) Office of Research Services (ORS) Division of Occupational Health and Safety (DOHS) Website (OD)	Form and Instruction	New	DOHS survey screenshot
235681	Website Survey for Website Satisfaction Rating (NIAAA)	Form and Instruction	New	NIAAA Website Survey Screenshot
235678	2019 DOCLINE User Satisfaction Survey (NLM)	Form	New	DOCLINE Survey instrument
235643	2019 Genetics Home Reference Survey (NLM)	Form	New	GHR Survey Instrument
235642	Rocky Mountain Lab - Family Care Survey 2019 (ORS/OD)	Form and Instruction	New	RML Family Care Survey Screenshot
235640	Scientific Research (SR) Maximizing Value (ORS/OD)	Form and Instruction	New	Post-Presentation screenshot
235640	Scientific Research (SR) Maximizing Value (ORS/OD)	Form and Instruction	New	Pre-Presentation Survey screenshot
235638	NCBI 2019 Run Selector Survey (NLM)	Form	New	NCBI Run Selector Survey Instrument
235604	Technology Transfer and Intellectual Property Officer (TTIPO) Fellowship Program Survey (NIAID)	Form	New	TTIPO Fellowship Survey screenshots
235490	2019 Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Investigators Meeting Conference Assessment Survey (NINDS)	Form and Instruction	New	BRAIN PI Mtg - Event App Survey Screenshots
235415	Regional Workshop: Alternative Approaches to Combating Anti-Microbial Resistance (AMR) (NIAID)	Form and Instruction	New	Post WorkshopEvaluation --US-KZ AMR 2019 screenshots
235380	2019 Clin Var User Survey (NLM)	Form	New	2019 ClinVar Survey
235334	2019 Data Science Services Survey (NLM)	Form and Instruction	New	Data Science Survey
235102	2019 NCBI BioProject/BioSample Survey (NLM)	Form	New	NCBI BioProject BioSample Survey
234936	ORDR Usability Testing of Web Resources for Rare Disease Patients (NCATS)	Form and Instruction	New	NCATS Toolkit RDD Test Plan
234936	ORDR Usability Testing of Web Resources for Rare Disease Patients (NCATS)	Form and Instruction	New	NCATS RaDaR RDD Test Plan
234936	ORDR Usability Testing of Web Resources for Rare Disease Patients (NCATS)	Form and Instruction	New	NCATS GARD RDD Test Plan
234899	2019 CT.gov Website Usability Survey (NLM)	Form	New	NLM 2019 CT Usability Survey
234845	Surveys to Support Assessment of the National Institute of Diabetes and Digestive and Kidney Diseases Office of Minority Health Research Coordination's Research and Training Opportunities for Students	Form	New	DSTRP survey instrument
234812	2019 NLM ClinicalTrials.gov Website Survey	Form	New	Clinical trials website survey
234772	Division of Veterinary Resources Customer Satisfaction Survey (OD)	Form and Instruction	New	GDB screenhots
234767	2019 NLM MedlinePlus Awareness Survey	Form	New	MedlinePlus Survey Instrument
234753	Statistics Customer Feedback Survey (NIH Library)	Form	New	Statistics CS Survey
234707	2019 PubMed User Satisfaction Survey (NLM)	Form	New	PubMed User Survey Instrument
234703	Children's Health Exposure Assessment Resource (CHEAR) Client Satisfaction Survey (NIEHS)	Form	New	CHEAR Client Satisfaction survey
234686	NCBI 2019 Protein Resource Needs Survey (NLM)	Form and Instruction	New	NCBI 2019 Protein Resource Survey
234683	NLM SIS Disaster Information Specialization Survey	Form and Instruction	New	DIS Survey Instrument
234682	2019 Occupational Illness and Injury Prevention Survey (OD)	Form and Instruction	New	ED DOHS OIIP Survey screenshot
234681	Intramural Research Program Office of Fellowship Training (OFT) Annual Trainee Survey (NIMH)	Form and Instruction	New	NIMH OFT Annual Trainee Survey Questions
234605	NLM Site-wide Survey for Website Satisfaction Rating 2019	Form	New	NLM Site-wide Survey for Website Satisfaction Rating 2019
234529	NLM Site-wide Survey for Website Satisfaction Rating 2019	Form and Instruction	New	NLM Site-wide Survey for Website Satisfaction Rating 2019
234515	Alcohol Research Current Review Author Feedback phone call	Form and Instruction	New	NIAAA Author Feedback Call
234504	NLM NCBI 2018 Population Frequency Data Survey	Form and Instruction	New	NLM NCBI 2018 Population Frequency Data Survey
234245	Questionnaire for assessing the needs to innovate, build, modify and fix laboratory tools & equipment (NIEHS)	Form	New	Equipment Survey
234244	NIH IT Service Desk Customer Satisfaction Survey (CIT)	Form	New	CIT Customer Satisfaction Survey Form
234199	Office of Dietary Supplements' Customer Feedback Assessment for ODS Scholars Awardees and Administrative Supplement Grantees (OD)	Form	New	ODS Administrative Supplement survey
234199	Office of Dietary Supplements' Customer Feedback Assessment for ODS Scholars Awardees and Administrative Supplement Grantees (OD)	Form	New	ODS Scholars Feedback Survey
234139	Customer Satisfaction Survey for the Innovative Clinical Trials Resource (ICTR) Website	Form	New	Innovative Clinical Trials Resource (ICTR) screenshot
233927	NLM NCBI 2018 BLAST Survey	Form	New	NCBI 2018 Blast Survey
233909	Health Science Data Needs Assessment (NLM)	Form	New	Health Science Data Needs As survey instrument
233841	NLM 2018 UMLS User Satisfaction Survey	Form and Instruction	New	UMLS 2018 User Survey
233824	NIH Library Survey on Electronic Lab Notebook Usage in NIH Intramural Labs	Form	New	ALivinski Library Survey Screenshots
233824	NIH Library Survey on Electronic Lab Notebook Usage in NIH Intramural Labs	Instruction	New
233692	Editing Service Customer Feedback Survey (NIHL)	Form	New	Survey
233667	Health Science Data Needs Assessment (NLM)	Form and Instruction	New	Health Science Data Needs Assessment
233641	ODP Pathways to Prevention Workshop Survey III	Form	New	P2P Post Survey Screenshots
233574	Change Readiness Survey (OD)	Form and Instruction	New	ChangeReadiness Survey screenshot
233479	Quick Feedback Center for Scientific Review (QFCSR)	Form	New	QFCSR Fall 2018
233458	The NIH Extramural Loan Repayment Programs: Online Customer Service Survey About the Application Technical Assistance Webinar	Form	New	FY2019 LRP Webinar Survey
233138	NLM NCBI 2018 Data Submission Survey	Form	New	NCBI Submission Survey
233036	Surveys to Support Assessment of the National Institute of Diabetes and Digestive and Kidney Diseases Office of Minority Health Research Coordination's Research and Training Opportunities for Students	Form and Instruction	New	STEP UP survey screenshot
232994	NLM 2018 Exhibition Program Web Portal Usability Study (Private Sector)	Form	New	NLM Exhibition Program Portal Usability Study Instrument
232993	NLM 2018 Exhibition Program Web Portal Usability Study (General Public)	Form	New	NLM Exhibition Program Portal Usability Study Instrument
232808	Amgen-alumni WhereAreYouNow (OITE)	Form	New	OMBFT-Amgen-Alumni-WhereAreYouNow
232800	NIH Office of Intramural Training & Education (OITE) – Amgen Scholars at NIH Feedback (OD)	Form	New	Amgen Scholars Feedback survey
232691	Human Genetics Resource Center Publication Survey (NINDS)	Form	New	NOVISurvey NINDS Publication Survey
232540	NIH On the Move Need Survey	Form	New	LD PRA Screenshots On the Move
232513	Division of Scientific Equipment and Instrumentation Services (DSEIS) Maintenance and Repair Services Survey	Form	New	DSEIS PRA Screenshots
232501	NLM NCBI 2018 Graphical Sequence Survey	Form	New	Graphical Sequence Display Survey
232413	NIH Library Instruction Customer Feedback Survey (NCI)	Form	New	NIH Library Screenshot
232412	Perception of Cool Down Day Survey	Form and Instruction	New	Cool Down Day BDS
232372	NCBI 2018 Gene Resource Survey (NLM)	Form	New	NCBI 2018 Gene Resource Survey Instrument
232146	Feedback on NIH Common Fund's High-Risk, High-Reward Research Symposium (OD)	Form	New	HRHR Symposium survey 2018
232096	NLM NCBI 2018 PubChem Resources Survey	Form	New	NCBI 2018 PubChem Survey Instrument
231930	National Institute of Mental Health (NIMH) Core Facility User Survey	Form	New	NIMH Core User Survey template
231906	NIEHS Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (State and Local)	Form	New	PEPH Aware Act Use Survey
231905	NIEHS Partnerships for Environmental Public Health (PEPH) Aware-Act-Use Private Sector	Form	New	PEPH Aware Act Use Survey
231904	NIEHS Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Ind. and Households)	Form	New	PEPH Aware Act Use Survey
231903	NIEHS Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Federal)	Form	New	PEPH Aware-Act-Use Survey
231896	Office of Intramural Training & Education (OITE) – How to Teach and Advise on Career Development Topics for the Next Generation of Biomedical Scientists: A Train-the-Trainers Event	Form	New	2018 Train-the-Trainers- (Federal) Feedback form
231853	2018 Train-the-Trainers (private) Feedback (OD)	Form	New	2018 Train-the-Trainers Feedback form
231848	NLM GeneEd User Survey	Form	New	GeneEd User Survey
231816	NLM NCBI 2018 Transcript Resources Survey	Form	New	NCBI 2018 Transcript Resources Survey
231795	HMD 2018 Traveling Exhibition Host Survey	Form	New	NLM HMD 2018 Traveling Exhibition Host Survey
231755	NLM NCBI 2018 Microbial Genome Resources Survey	Form and Instruction	New	NCBI Microbial Genome Resources Survey
231718	CSR New Chair Orientation Survey	Form and Instruction	New	CSR New Chair Orientation
231708	National Institute of Mental Health (NIMH) Outreach Partnership Program Annual Meeting Assessment Form	Form	New	2018 OPP Mtg Assessment Form
231692	NLM Websites User Satisfaction 2018 Survey	Form	New	NLM Websites Survey
231573	BYOMM After Action Report (NIMHD)	Form	New	BYOMM After Action
231431	NLM MedlinePlus Website Usability Survey	Form and Instruction	New	User Survey Instrument NLM MedlinePlus Website
230718	Workflow information Tracking System (WiTS) Focus Groups	Form and Instruction	New	WiTS Focus Group Instrument
230717	Basic Electronic Survey to Inform Development of a Nursing Research Brochure	Form and Instruction	New	Survey Instrument
230717	Basic Electronic Survey to Inform Development of a Nursing Research Brochure	Form and Instruction	New	Survey Screenshots
230716	NIH Library Customer Satisfaction Survey	Form and Instruction	New	Survey with Burden Disclosure Statement
230703	Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Federal Government)	Form and Instruction	New	PEPH Aware Act Use Survey
230702	Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (State, Local, and Tribal)	Form and Instruction	New	PEPH Aware Act Use Survey Final
230701	Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Private Sector)	Form and Instruction	New	PEPH Aware Act Use Survey
230700	Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Individuals and Households)	Form and Instruction	New	PEPH Aware Act Use Survey Final
230698	National Institute of Mental Health (NIMH) Professional Coalition for Research Progress Meeting Assessment Form	Form and Instruction	New	NIMH Professional Coalition for Research Progress Meeting Assessment Form
230697	National Eye Institute (NEI) Eye Health Focus Groups with New Audiences Ages 25-35	Form and Instruction	New	Guide New Aud Attachment B
230697	National Eye Institute (NEI) Eye Health Focus Groups with New Audiences Ages 25-35	Form and Instruction	New	New Aud FG Attachment A Screnner
230696	HMD 2018 Exhibition Program Web Usability Study	Form and Instruction	New	HMD 2018 Exhibition Web Usability Study Instrument
230666	2018 NLM SIS Emerging Adults Health Needs Assessment	Form and Instruction	New	SIS Emerging Adults Focus Group Survey
230571	NCBI ClinVar 2017 Website User Survey (NLM)	Form	New	NCBI ClinVar 2017 Survey instrument
230530	NIH Office of Intramural Training & Education (OITE) – Career Service Center Feedback	Form	New	2018 Feedback Career Service Center
230416	NLM NCBI 2018 Genetics and Population Frequency Data Survey	Form	New	NCBI 2018 Genetics and Population Frequency Data Survey
230274	NLM 2018 Public Libraries Association Survey	Form and Instruction	New	2018 Public Libraries Survey instrument
230218	DrugAbuse.gov Website Feedback Survey	Form and Instruction	New	NIDA- Website Feedback Survey Screenshots
230204	NLM Toxnet 2018 Workshop Survey	Form and Instruction	New	NLM TOXNET 2018 Workshop Survey instrument
230166	Office of Human Resources (OHR) Pulse Survey	Form and Instruction	New	OHR Pulse Survey
230165	HR Systems Support (HRSS) Customer Satisfaction Survey	Form and Instruction	New	NIH HRSS Customer Satisfaction Survey
230164	Division of Senior and Scientific Executive Management (DSSEM) Application and Interview Satisfaction Survey	Form and Instruction	New	DSSEM Application and Interview Survey
230163	Office of Human Resources (OHR) Climate Survey	Form and Instruction	New	2017 OHR Climate Survey
230162	Office of Human Resources (OHR) Training Survey	Form and Instruction	New	P2P Survey Screenshots
230161	WiTS Climate Survey 2015	Form and Instruction	New	2015 WiTS Climate Survey
230160	Benefits & Payroll Liaison Branch (BLPB) Customer Satisfaction Survey	Form and Instruction	New	Retiree Survey
230159	Medicine: NIH Mind the Gap Webinar Series Survey II	Form	New	MtG Customer Satisfaction Survey
230158	Pathways to Prevention - Non-profit	Form	New	P2P Survey screenshots
230157	ODP Pathways to Prevention survey	Form	New	P2P Survey screenshots
230156	"The Nuts and Bolts of Group Randomized Trials" Participant Feedback Survey	Form	New	Survey/Monkey
230151	KAI Data and Saftey Monitoring Meeting E	Form	New	KAI Research Questions for NIAMS Customer Survey
230149	NIMH Website Survey	Form	New	NIMH Website Survey Screenshots
230148	NIMH Information Resource Center (IRC) Customer Satisfaction Surveys for Email Information Services, Online Publications Ordering Services and Telephone Services	Form	New	Online Publication Ordering Survey
230148	NIMH Information Resource Center (IRC) Customer Satisfaction Surveys for Email Information Services, Online Publications Ordering Services and Telephone Services	Form	New	Email Service survey
230148	NIMH Information Resource Center (IRC) Customer Satisfaction Surveys for Email Information Services, Online Publications Ordering Services and Telephone Services	Form	New	Telephone Service Customer Satisfaction survey
230138	NCBI 2017 Website User Survey	Form and Instruction	New	NCBI 2017 Website User Survey Instrument
230134	NLM NCBI 2018 Literature Resources Survey	Form and Instruction	New	NCBI 2018 Literature Resources Survey
230133	NLM Traveling Exhibition Visitor Study	Form and Instruction	New	NLM Traveling Exhibition Visitor Survey
230131	NLM NCBI 2018 Representative Genomes Survey	Form and Instruction	New	NCBI 2018 Representative Genomes Survey
230130	NLM Website Survey for Website Satisfaction Rating	Form and Instruction	New	NLM Website Survey Instrument
230122	Pediatric Patient Perception Survey (CC)	Form	New	NRC NIH Inpatient Pediatric Survey
230121	Health Information Technology Patient Satisfaction Survey (CC)	Form	New	Patient Portal Online Survey Screenshot
230120	Patient Perception Survey (CC)	Form	New	NIH Outpatient Mock-up -NRC Health
230120	Patient Perception Survey (CC)	Form	New	NIH Inpatient Mock-up - NRC Health
230119	Children's Health Exposure Assessment Resource (CHEAR) Client Satisfaction Survey(NIEHS)	Form	New	CHEAR Client Satisfaction Survey
230118	NIH Office of Intramural Training & Education (OITE) - NIH Native American Visit Week Feedback	Form	New	NAVisit week Collection
230117	NIH Office of Intramural Training & Education (OITE) - Management Boot Camp Feedback	Form	New	Management Boot Camp form
230116	NIH Office of Intramural Training & Education (OITE) - Graduate & Professional School Fair Feedback	Form	New	Graduate & Professional School Fair Feedback Collection
230115	NIH Office of Intramural Training & Education (OITE) - General Feedback Forms	Form	New	General Feedback Collection form
230114	NIH Office of Intramural Training & Education (OITE) Community College Day Feedback	Form	New	Community College Day feedback
230113	NIH Office of Intramural Training & Education (OITE) 2018 Feedback Career Symposium	Form	New	Career Symposium Collection Form
230111	The Annual NIH Pain consortium Symposium Feedback	Form	New	Pain 2015 Survey Monkey
230102	The NINDS Public Site Widget	Form	New	NINDS Public Site Widget screenshot

ICR Details

OMB Control No: 0925-0648	ICR Reference No: 201802-0925-002
Status: Historical Active	Previous ICR Reference No: 201501-0925-004
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/01/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/27/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2021	36 Months From Approved	04/30/2018
Responses	1,059,000	0	759,000
Time Burden (Hours)	147,999	0	148,074
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable the National Institutes of Health to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the agency's programs.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 60754	12/22/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 11219	03/14/2018
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 136

table that charts list of burden

IC Title	Form No.	Form Name
Human Genetics Resource Center Publication Survey (NINDS)	1	NOVISurvey NINDS Publication Survey
NCBI 2019 Protein Resource Needs Survey (NLM)	1	NCBI 2019 Protein Resource Survey
"The Nuts and Bolts of Group Randomized Trials" Participant Feedback Survey	1	Survey/Monkey
2018 NLM SIS Emerging Adults Health Needs Assessment	1	SIS Emerging Adults Focus Group Survey
2018 Train-the-Trainers (private) Feedback (OD)	1	2018 Train-the-Trainers Feedback form
2019 Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Investigators Meeting Conference Assessment Survey (NINDS)	1	BRAIN PI Mtg - Event App Survey Screenshots
2019 CT.gov Website Usability Survey (NLM)	1	NLM 2019 CT Usability Survey
2019 Clin Var User Survey (NLM)	1	2019 ClinVar Survey
2019 DOCLINE User Satisfaction Survey (NLM)	1	DOCLINE Survey instrument
2019 Data Science Services Survey (NLM)	1	Data Science Survey
2019 Genetics Home Reference Survey (NLM)	1	GHR Survey Instrument
2019 NCBI BioProject/BioSample Survey (NLM)	1	NCBI BioProject BioSample Survey
2019 NLM ClinicalTrials.gov Website Survey	1	Clinical trials website survey
2019 NLM MedlinePlus Awareness Survey	1	MedlinePlus Survey Instrument
2019 Nonprofit Forum on-site meeting feedback (NINDS)	1	2019 Nonprofit Forum on-site meeting feedback survey
2019 Occupational Illness and Injury Prevention Survey (OD)	1	ED DOHS OIIP Survey screenshot
2019 PubMed User Satisfaction Survey (NLM)	1	PubMed User Survey Instrument
Alcohol Research Current Review Author Feedback phone call	1	NIAAA Author Feedback Call
Amgen-alumni WhereAreYouNow (OITE)	1	OMBFT-Amgen-Alumni-WhereAreYouNow
Assist User Experience	1	Assist User Experience
BYOMM After Action Report (NIMHD)	1	BYOMM After Action
Basic Electronic Survey to Inform Development of a Nursing Research Brochure	1, 1	Survey Screenshots ,   Survey Instrument
Benefits & Payroll Liaison Branch (BLPB) Customer Satisfaction Survey	1	Retiree Survey
Brother Your On My Mind (BYOMM) Knowledge Attitudes and Belief (KAB) (NIMHD)	1	BYOMM KAB
CSR New Chair Orientation Survey	1	CSR New Chair Orientation
Change Readiness Survey (OD)	1	ChangeReadiness Survey screenshot
Children's Health Exposure Assessment Resource (CHEAR) Client Satisfaction Survey (NIEHS)	1	CHEAR Client Satisfaction survey
Children's Health Exposure Assessment Resource (CHEAR) Client Satisfaction Survey(NIEHS)	1	CHEAR Client Satisfaction Survey
Customer Satisfaction Survey for the Innovative Clinical Trials Resource (ICTR) Website	1	Innovative Clinical Trials Resource (ICTR) screenshot
Division of Scientific Equipment and Instrumentation Services (DSEIS) Maintenance and Repair Services Survey	1	DSEIS PRA Screenshots
Division of Senior and Scientific Executive Management (DSSEM) Application and Interview Satisfaction Survey	1	DSSEM Application and Interview Survey
Division of Veterinary Resources Customer Satisfaction Survey (OD)	1	GDB screenhots
DrugAbuse.gov Website Feedback Survey	1	NIDA- Website Feedback Survey Screenshots
Editing Service Customer Feedback Survey (NIHL)	1	Survey
Feedback on NIH Common Fund's High Risk, High-Reward Research Symposium (OD)	1	HRHR Symposium Satisfaction Survey
Feedback on NIH Common Fund's High-Risk, High-Reward Research Symposium (OD)	1	HRHR Symposium survey 2018
Focus Group for Primary Care Providers Regarding Alcohol Treatment (NIAAA)	1, 2	Navigator Screener Round 2 ,   Physicians Moderator Guide
HMD 2018 Exhibition Program Web Usability Study	1	HMD 2018 Exhibition Web Usability Study Instrument
HMD 2018 Traveling Exhibition Host Survey	1	NLM HMD 2018 Traveling Exhibition Host Survey
HR Systems Support (HRSS) Customer Satisfaction Survey	1	NIH HRSS Customer Satisfaction Survey
Health Information Technology Patient Satisfaction Survey (CC)	1	Patient Portal Online Survey Screenshot
Health Science Data Needs Assessment (NLM)	1	Health Science Data Needs As survey instrument
Health Science Data Needs Assessment (NLM)	1	Health Science Data Needs Assessment
Intramural Research Program Office of Fellowship Training (OFT) Annual Trainee Survey (NIMH)	1	NIMH OFT Annual Trainee Survey Questions
KAI Data and Saftey Monitoring Meeting E	1	KAI Research Questions for NIAMS Customer Survey
Literature Search Customer Feedback Survey (NIH Library)	1	Literature Survey
Medicine: NIH Mind the Gap Webinar Series Survey II	1	MtG Customer Satisfaction Survey
NCBI 2017 Website User Survey	1	NCBI 2017 Website User Survey Instrument
NCBI 2018 Gene Resource Survey (NLM)	1	NCBI 2018 Gene Resource Survey Instrument
NCBI 2019 Genome Resource Survey (NLM)	1	NCBI 2019 Genome Survey
NCBI 2019 Identical Protein Groups (NLM)	1	NCBI IPG survey
NCBI 2019 Run Selector Survey (NLM)	1	NCBI Run Selector Survey Instrument
NCBI ClinVar 2017 Website User Survey (NLM)	1	NCBI ClinVar 2017 Survey instrument
NIEHS Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Federal)	1	PEPH Aware-Act-Use Survey
NIEHS Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Ind. and Households)	1	PEPH Aware Act Use Survey
NIEHS Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (State and Local)	1	PEPH Aware Act Use Survey
NIEHS Partnerships for Environmental Public Health (PEPH) Aware-Act-Use Private Sector	1	PEPH Aware Act Use Survey
NIH IT Service Desk Customer Satisfaction Survey (CIT)	1	CIT Customer Satisfaction Survey Form
NIH Library Customer Satisfaction Survey	1	Survey with Burden Disclosure Statement
NIH Library Instruction Customer Feedback Survey (NCI)	1	NIH Library Screenshot
NIH Library Survey on Electronic Lab Notebook Usage in NIH Intramural Labs	1	ALivinski Library Survey Screenshots
NIH Office of Intramural Training & Education (OITE) - General Feedback Forms	2	General Feedback Collection form
NIH Office of Intramural Training & Education (OITE) - Graduate & Professional School Fair Feedback	1	Graduate & Professional School Fair Feedback Collection
NIH Office of Intramural Training & Education (OITE) - Management Boot Camp Feedback	1	Management Boot Camp form
NIH Office of Intramural Training & Education (OITE) - NIH Native American Visit Week Feedback	1	NAVisit week Collection
NIH Office of Intramural Training & Education (OITE) 2018 Feedback Career Symposium	1	Career Symposium Collection Form
NIH Office of Intramural Training & Education (OITE) Community College Day Feedback	1	Community College Day feedback
NIH Office of Intramural Training & Education (OITE) – Amgen Scholars at NIH Feedback (OD)	1	Amgen Scholars Feedback survey
NIH Office of Intramural Training & Education (OITE) – Career Service Center Feedback	1	2018 Feedback Career Service Center
NIH On the Move Need Survey	1	LD PRA Screenshots On the Move
NIMH Information Resource Center (IRC) Customer Satisfaction Surveys for Email Information Services, Online Publications Ordering Services and Telephone Services	1, 2, 3	Telephone Service Customer Satisfaction survey ,   Email Service survey ,   Online Publication Ordering Survey
NIMH Website Survey	1	NIMH Website Survey Screenshots
NLM 2018 Exhibition Program Web Portal Usability Study (General Public)	1	NLM Exhibition Program Portal Usability Study Instrument
NLM 2018 Exhibition Program Web Portal Usability Study (Private Sector)	1	NLM Exhibition Program Portal Usability Study Instrument
NLM 2018 Public Libraries Association Survey	1	2018 Public Libraries Survey instrument
NLM 2018 UMLS User Satisfaction Survey	1	UMLS 2018 User Survey
NLM GeneEd User Survey	1	GeneEd User Survey
NLM MedlinePlus Website Usability Survey	1	User Survey Instrument NLM MedlinePlus Website
NLM NCBI 2018 BLAST Survey	1	NCBI 2018 Blast Survey
NLM NCBI 2018 Data Submission Survey	1	NCBI Submission Survey
NLM NCBI 2018 Genetics and Population Frequency Data Survey	1	NCBI 2018 Genetics and Population Frequency Data Survey
NLM NCBI 2018 Graphical Sequence Survey	1	Graphical Sequence Display Survey
NLM NCBI 2018 Literature Resources Survey	1	NCBI 2018 Literature Resources Survey
NLM NCBI 2018 Microbial Genome Resources Survey	1	NCBI Microbial Genome Resources Survey
NLM NCBI 2018 Population Frequency Data Survey	1	NLM NCBI 2018 Population Frequency Data Survey
NLM NCBI 2018 PubChem Resources Survey	1	NCBI 2018 PubChem Survey Instrument
NLM NCBI 2018 Representative Genomes Survey	1	NCBI 2018 Representative Genomes Survey
NLM NCBI 2018 Transcript Resources Survey	1	NCBI 2018 Transcript Resources Survey
NLM SIS Disaster Information Specialization Survey	1	DIS Survey Instrument
NLM Site-wide Survey for Website Satisfaction Rating 2019	1	NLM Site-wide Survey for Website Satisfaction Rating 2019
NLM Site-wide Survey for Website Satisfaction Rating 2019	1	NLM Site-wide Survey for Website Satisfaction Rating 2019
NLM Toxnet 2018 Workshop Survey	1	NLM TOXNET 2018 Workshop Survey instrument
NLM Traveling Exhibition Visitor Study	1	NLM Traveling Exhibition Visitor Survey
NLM Website Survey for Website Satisfaction Rating	1	NLM Website Survey Instrument
NLM Websites User Satisfaction 2018 Survey	1	NLM Websites Survey
National Eye Institute (NEI) Eye Health Focus Groups with New Audiences Ages 25-35	2, 1	New Aud FG Attachment A Screnner ,   Guide New Aud Attachment B
National Institute of Mental Health (NIMH) Core Facility User Survey	1	NIMH Core User Survey template
National Institute of Mental Health (NIMH) Outreach Partnership Program Annual Meeting Assessment Form	1	2018 OPP Mtg Assessment Form
National Institute of Mental Health (NIMH) Professional Coalition for Research Progress Meeting Assessment Form	1	NIMH Professional Coalition for Research Progress Meeting Assessment Form
ODP Pathways to Prevention Workshop Survey III	1	P2P Post Survey Screenshots
ODP Pathways to Prevention survey	1	P2P Survey screenshots
OIT Training Customer Satisfaction Survey (OD)	1	OITBrownBag survey
ORDR Usability Testing of Web Resources for Rare Disease Patients (NCATS)	3, 1, 2	NCATS GARD RDD Test Plan ,   NCATS RaDaR RDD Test Plan ,   NCATS Toolkit RDD Test Plan
Office of Dietary Supplements' Customer Feedback Assessment for ODS Scholars Awardees and Administrative Supplement Grantees (OD)	1, 2	ODS Scholars Feedback Survey ,   ODS Administrative Supplement survey
Office of Human Resources (OHR) Climate Survey	1	2017 OHR Climate Survey
Office of Human Resources (OHR) Pulse Survey	1	OHR Pulse Survey
Office of Human Resources (OHR) Training Survey	1	P2P Survey Screenshots
Office of Intramural Training & Education (OITE) – How to Teach and Advise on Career Development Topics for the Next Generation of Biomedical Scientists: A Train-the-Trainers Event	1	2018 Train-the-Trainers- (Federal) Feedback form
Participant Feedback for the Mary Frances Picciano Dietary Supplement Research Practicum (DSRP) on May 29–31, 2019 at the Lister Hill Auditorium (NLM)	1, 2, 3	Evaluation Day 1 screenshot ,   Evaluation Day 2 screenshot ,   Evaluation Day 3 screenshot
Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Federal Government)	1	PEPH Aware Act Use Survey
Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Individuals and Households)	1	PEPH Aware Act Use Survey Final
Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Private Sector)	1	PEPH Aware Act Use Survey
Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (State, Local, and Tribal)	1	PEPH Aware Act Use Survey Final
Pathways to Prevention - Non-profit	1	P2P Survey screenshots
Patient Perception Survey (CC)	1, 2	NIH Inpatient Mock-up - NRC Health ,   NIH Outpatient Mock-up -NRC Health
Pediatric Patient Perception Survey (CC)	1	NRC NIH Inpatient Pediatric Survey
Perception of Cool Down Day Survey	1	Cool Down Day BDS
Questionnaire for assessing the needs to innovate, build, modify and fix laboratory tools & equipment (NIEHS)	1	Equipment Survey
Quick Feedback Center for Scientific Review (QFCSR)	1	QFCSR Fall 2018
Regional Workshop: Alternative Approaches to Combating Anti-Microbial Resistance (AMR) (NIAID)	1	Post WorkshopEvaluation --US-KZ AMR 2019 screenshots
Rocky Mountain Lab - Family Care Survey 2019 (ORS/OD)	1	RML Family Care Survey Screenshot
SR Maximizing Value 3Month Post (ORS/OD)	1	KOliver Screenshots
Scientific Research (SR) Maximizing Value (ORS/OD)	1, 2	Pre-Presentation Survey screenshot ,   Post-Presentation screenshot
Soliciting Feedback About the National Institutes of Health (NIH) Office of the Director (OD) Office of Research Services (ORS) Division of Occupational Health and Safety (DOHS) Website (OD)	1	DOHS survey screenshot
Soliciting Feedback on the Omics Nursing & Education Network (ONSEN) Website (NINR)	1	ONSEN survey
Statistics Customer Feedback Survey (NIH Library)	1	Statistics CS Survey
Survey to Assess the Quality of Grant Review Among NIH Center for Scientific Review Reviewers (CSR)	1	Survey
Surveys to Support Assessment of the National Institute of Diabetes and Digestive and Kidney Diseases Office of Minority Health Research Coordination's Research and Training Opportunities for Students	1	STEP UP survey screenshot
Surveys to Support Assessment of the National Institute of Diabetes and Digestive and Kidney Diseases Office of Minority Health Research Coordination's Research and Training Opportunities for Students	1	DSTRP survey instrument
Technology Transfer and Intellectual Property Officer (TTIPO) Fellowship Program Survey (NIAID)	1	TTIPO Fellowship Survey screenshots
The Annual NIH Pain consortium Symposium Feedback	1	Pain 2015 Survey Monkey
The NIH Extramural Loan Repayment Programs: Online Customer Service Survey About the Application Technical Assistance Webinar	1	FY2019 LRP Webinar Survey
The NINDS Public Site Widget	1	NINDS Public Site Widget screenshot
Website Survey for Website Satisfaction Rating (NIAAA)	1	NIAAA Website Survey Screenshot
WiTS Climate Survey 2015	1	2015 WiTS Climate Survey
Workflow information Tracking System (WiTS) Focus Groups	1	WiTS Focus Group Instrument

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,059,000	759,000	0	300,000	0	0
Annual Time Burden (Hours)	147,999	148,074	0	-75	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: there is a difference of -75 in the burden being requested due to mathematical computation from the previously, approved submission. Additionally, the number of responses has increased by 300,000 due to new requirements regarding the reporting of “Responses per Respondent.”

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Annual Cost to Federal Government: $350,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/27/2018

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