RKL 1-2 Mockup Survey OMB Form

Request for Approval under the “Generic Clearance”

(OMB#: 0925-0642; Exp. Date: 05/31/2020)

TITLE OF INFORMATION COLLECTION: Rockledge 1 and 2 Furniture Mockup Feedback

PURPOSE:

We are collecting information for the consolidation of several NIH Institutes/Center (ICs) to– Rockledge I and II. We are sending the survey to the employees and on-site contractors of the NIH Organizations who will be impacted by the move.

We are asking the federal employees and the contractors who work in their space to participate in a web-based survey that will help us understand assessment of the three furniture configurations presented in mock-up form. Questions focus on construction quality, flexibility, technology integration, wire management, and ergonomics.

DESCRIPTION OF RESPONDENTS:

The respondents are the NIH federal employees and their contractors who will be consolidating their office space into the project location noted above.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [ x ] Other: Feedback ___________________

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: Jay Hull

COR II, FAC-P/PM II

Office of Research Facilities Development and Operations

Division of Design and Construction Management

Management Systems

Building 13, Room 2W48

9000 Rockville Pike, Bethesda, MD 20892-5748

Cell (301) 792-0534

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

Category of Respondent	No. of Respondents	No. of Responses per Respondent	Time per Response (in hours)	Total Burden Hours
Individuals (Federal Government Contractors)	3000	1	5/60	250
Totals		3000		250

Category of Respondent	Total Burden Hours	Hourly Wage Rate*	Total Burden Cost
Individuals (Federal Government Contractors)	250	$30	$7500
Totals		$30	$7500

*Cite source per bls.gov, if applicable.

http://www.bls.gov/oes/current/naics4_622300.htm#00-0000

FEDERAL COST: The estimated annual cost to the Federal government is $1478.15.

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Communication Director	GS14/10	145,629	0.005		728.15
Contractor Cost					750
Travel					n/a
Other Cost					n/a
Total					1478.15

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 list of respondents includes the staff for each of the NIH Institutes/Centers that are part of the two consolidation projects. The number of staff for the Rockledge 1 and II consolidation is approximately 3,000. The number of staff for the 6700B move is approximately 500.

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

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

5