Fast track template NIMH IRC Customer Satisfaction Surveys

Request for Approval under the “Generic Clearance for the Collection of
Routine Customer Feedback” (OMB#: 0925-0648; Exp. Date: 03/2018)
TITLE OF INFORMATION COLLECTION:
NIMH Information Resource Center (IRC) Customer Satisfaction Surveys for Email Information
Services, Online Publications Ordering Services and Telephone Services
PURPOSE:
The National Institute of Mental Health (NIMH) Information Resource Center wishes to gauge
customer satisfaction with their email information and referral service, telephone-based service,
and the process to order materials from our online publications catalog. Respondents are given
the option to participate in a survey by clicking on a survey link located at the end of an
information resource center email response, clicking on a link provided on our online
publications catalog at the end of their online ordering session, or by opting to participate in an
interactive voice response telephone survey upon completion of a telephone call with an NIMH
information specialist. The information gathered helps identify strengths and weaknesses of
current services and guide improvements in service delivery based on customer feedback.
DESCRIPTION OF RESPONDENTS:
Individuals who send email inquiries to [email protected] and voluntarily click on the survey
link in their email response; individuals who call the NIMH Information Resource Center and
voluntarily agree to participate in the interactive voice response survey upon completing a
telephone call with an NIMH information specialist; individuals who visit the NIMH Information
Resource Center to order publications via the online catalog and voluntarily click on the
provided survey link.
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: Antoinette Boswell, Contracting Officer’s Representative, NIMH

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

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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? N/A [ ] Yes [ ] 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
Individuals/Households
(email services survey)
Individuals/Households
(online publications
ordering services survey)
Individuals/Households
(telephone services
survey)
Totals

No. of Respondents

No. of
Responses
per
Respondent

Time per
Response
(in hours)

Total
Burden
Hours

60

1

3/60

3

1,900

1

3/60

95

60

1

2/60

2

2,020

2,020

100

Total Burden
Hours

Hourly Wage Rate*

Total Burden
Cost

Individuals/Households

100

$22.71

$2,271

Totals

100

$22.71

$2,271

Category of Respondent

*United States Department of Labor Bureau of Labor Statistics (May 2014) National
Occupational Employment and Wages by Major Occupational Group (All Occupations) – see
http://www.bls.gov/oes/current/oes_nat.htm#00-0000.
FEDERAL COST: The estimated annual cost to the Federal government is $38,587

Staff
Federal Oversight
Health Communications
Specialist

Grade/Step

Salary

% of
Effort

GS-11

$70,000

40%

2

Fringe (if Total Cost
applicable) to Gov’t

$28,000

Contractor Cost
Sr. Evaluation Specialist
Bilingual Health
Information Specialist
Writer/Editor
Project Manager
Web/IT
IVR modification,
testing, implementation
(vendor)

N/A
N/A
N/A
N/A
N/A
N/A

$79.73/hr

9 hrs

$44.20/hr
$94.10/hr
$115.09/hr.
$171.84/hr
N/A

2 hrs
4 hrs
10 hrs
20 hrs
N/A

$718
$88
$376
$972
$3,437
$4,996

Travel
Other Cost

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?
[ ] Yes [X] 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?
Respondents who contact the NIMH Information Resource Center and wish to complete
the survey(s) will voluntarily do so.

Administration of the Instrument
1. How will you collect the information? (Check all that apply)
[X] Web-based or other forms of Social Media
[X] 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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