fast track for NIEHS DERT Climate Survey

Fast Track Template- NIEHS DERT Climate Survey.docx

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

fast track for NIEHS DERT Climate Survey

OMB: 0925-0648

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

Shape1 TITLE OF INFORMATION COLLECTION: NIEHS DERT Climate Assessment


PURPOSE:

The NIH Civil Program is soliciting feedback from staff members to evaluate satisfaction with the work environment and to identify any areas of concern.




DESCRIPTION OF RESPONDENTS:

Staff members in NIEHS’ Division of Extramural Research and Training (DERT) office




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: Sylvia Chen


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 [ ] 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/household

70

1

10/60

12

Totals


70


12


COST TO RESPONDENT


Category of Respondent


Total Burden

Hours

Hourly Wage Rate*

Total Burden Cost

Federal Government Staff

12

$27.08

$324.96

Totals



$324.96

Bls.gov Occupational Employment and Wages, May 2019, Washington DC Metropolitan Division https://www.bls.gov/oes/current/oes_47900.htm#00-0000



FEDERAL COST: The estimated annual cost to the Federal government is $1,129.30


Staff


Grade/Step

Salary*

% of Effort

Fringe (if applicable)

Total Cost to Gov’t

Federal Oversight






Analytics Lead

GS 13/4

$112,930

1%


$1,129.30













Contractor Cost












Travel






Other Cost












Total





$1,129.30

*the Salary in table above is cited from https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2020/DCB.pdf



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 survey will be distributed to all staff working in NIEHS DERT. Participation is completely voluntary.




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

  1. Will interviewers or facilitators be used? [ ] Yes [ x ] No

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


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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleGeneric Clearance Submission Template
SubjectGeneric Clearance Submission Template
AuthorOD/USER
File Modified0000-00-00
File Created2021-01-12

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