Generic Clearance Submission Template

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Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0925-0648, Exp. Date: 05/31/2021)
TITLE OF INFORMATION COLLECTION:  

ORS Scientific Research (SR) Maximizing Value

PURPOSE:  

To measure the effectiveness of a slide presentation to NIH Intramural Research Scientists and related groups in raising awareness of the services and resources of NIH Office of Research Services Scientific Resources Divisions and Medical Arts Branch.


DESCRIPTION OF RESPONDENTS: 

NIH Intramural Research Scientists and related groups

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: Keith Cogdill, PhD, Director, Division of Library Services, Office of Research Services
Address: Bldg. 10, 1L25F, MSC 1150, Bethesda, MD 20892-1150
Telephone Number: (301) 827-3792

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

Personally Identifiable Information:
    1. Is personally identifiable information (PII) collected?  [ X ] Yes  [ ]  No 
    2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974?   [ X ] 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 
Individuals/Households
1,200
2
5/60
200





Totals

2,400

200


 Category of Respondent

Total Burden
Hours
Hourly Wage Rate*
Total Burden Cost 
NIH Employees
& Post-Doctoral Fellows

200

$50

$10,000




Totals


$10,000
*https://www.bls.gov/oes/2017/May/oes_nat.htm#00-0000  




















FEDERAL COST:  The estimated annual cost to the Federal government is $10,000. 

                    
 Staff

Grade/Step
Salary
% of Effort
Fringe (if applicable)
Total Cost to Gov’t
Federal Oversight





Director, DLS
15/7
161,796
5

 $8,090
Evaluation Expert
13/5
109,903
5

 $5,495






Contractor Cost

121,322
5

 $6,006






Travel





Other Cost











Total




$19,591
*https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/2018/general-schedule/

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 recruit Laboratories for participation in the piloting of the presentation, and evaluate, via a pre-presentation survey, a presentation evaluation survey and a post-presentation survey, 3 months out. The data collected with be analyzed quantitatively, using statistical software.

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	
[ X ] In-person	
[ X ] Mail 
[  ] Other, Explain 

    2. Will interviewers or facilitators be used?  [  ] Yes [ X] No
 
Please make sure that all instruments, instructions, and scripts are submitted with the request.