Fast Track Generic-One Pager WISDOM

Request for Approval under the “Fast Track Generic Clearance for the
Collection of Routine Customer Feedback” (OMB Control Number: 0704-0553)
TITLE OF INFORMATION COLLECTION:
Customer Satisfaction Survey of WISDOM course graduates (in the last three years)
PURPOSE:
There is a need to determine the value of the WISDOM course to the Military Health System
(MHS). The survey will examine satisfaction/utilization of the information provided in the
course.

DESCRIPTION OF RESPONDENTS:
Respondents are Military, Civilian and Contractors who have completed the WISDOM course in
the past three years.

TYPE OF COLLECTION: (Check one)
[ ] Customer Comment Card/Complaint Form
[ ] Usability Testing (e.g., Website or Software
[ ] Focus Group

[X] Customer Satisfaction Survey
[ ] Small Discussion 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:____Melissa Gliner, PhD____________________________________________
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, will any information that is collected be included in records that are subject to the
Privacy Act of 1974? [ ] Yes [ ] No
3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No
Gifts or Payments:
Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to
participants? [ ] Yes [ X ] No

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BURDEN HOURS
Category of Respondent

No. of
Respondents
266
69
335

Civilian/Military
Contractor
Totals

Participation
Time
5 minutes
5 minutes
5 minutes

Burden
22
6
28 hours

FEDERAL COST: The estimated annual cost to the Federal government is __$5,000_______
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 a census of all WISDOM graduates in the past three years.

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.

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