Form 1 IRC Customer Satisfaction survey

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

NIMH IRC Customer Satisfaction Surveys

Information Resource Center (IRC) Customer Satisfaction Surveys for Email Information Services and Online Publications Ordering Services (NIMH)

OMB: 0925-0648

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OMB Control Number 0925-0648

Expiration Date: May 31, 2021


NIMH Email Services Customer Satisfaction Survey




Public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate, or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, Maryland 20892-7974, ATTN: PRA (0925-0648). Do not return the completed form to this address.


This federal government-sponsored survey should take approximately 3 minutes to complete. Your responses will be protected to the extent allowed by law. Participation is voluntary; you may decline to answer any or all of the questions.



1. Which of the following categories best describes your role when requesting National Institute of Mental Health information? (Select only one category.)


o Advocate or advocacy organization

o Clinician: Medical doctor

o Clinician: Nurse practitioner

o Clinician: Nurse (e.g., RN)

o Clinician: Psychiatrist

o Clinician: Psychologist

o Clinician: Social worker

o Clinician: Other (e.g., substance use counselor, physician assistant)

o Congressional member or staff

o Educator: K-12

o Educator: Post-secondary



o Emergency responder

o Faith-based community

o Health educator/information specialist

o Government employee or agency

o Law enforcement/police/court system

o Media (e.g., reporter)

o Military service member

o Prisoner/inmate/detainee

o Researcher

o Seeking help for self

o Seeking help for someone else

o Student: K-12

o Student: Post-secondary

o Other (please specify) _



2. How timely was the response you received to your inquiry?


o Very timely

o Timely

o Somewhat timely

o Delayed

o Very delayed



3. How helpful was the information you received?


o Very helpful

o Helpful

o Somewhat helpful

o Not helpful

o Not at all helpful


If you selected “Not helpful” or “Not at all helpful,” please explain: [Open text field]



4. How satisfied were you with the customer service you received?


o Very satisfied

o Satisfied

o Somewhat satisfied

o Unsatisfied

o Very unsatisfied


If you selected “Unsatisfied” or “Very unsatisfied,” please explain: [Open text field]



5. Do you have additional comments about our email services? [Open text field]



Thank you for your time and participation!

[“Submit” button]



NIMH Online Publications Ordering Services Customer Satisfaction Survey




Public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate, or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, Maryland 20892-7974, ATTN: PRA (0925-0648). Do not return the completed form to this address.


This federal government-sponsored survey should take approximately 3 minutes to complete. Your responses will be protected to the extent allowed by law. Participation is voluntary; you may decline to answer any or all of the questions.



1. Which of the following categories best describes your role when ordering National Institute of Mental Health publications? (Check only one category.)


o Advocate or advocacy organization

o Clinician: Medical doctor

o Clinician: Nurse practitioner

o Clinician: Nurse (e.g., RN)

o Clinician: Psychiatrist

o Clinician: Psychologist

o Clinician: Social worker

o Clinician: Other (e.g., substance use counselor, physician assistant)

o Congressional member or staff

o Educator: K-12

o Educator: Post-secondary



o Emergency responder

o Faith-based community

o Health educator/information specialist

o Government employee or agency

o Law enforcement/police/court system

o Media (e.g., reporter)

o Military service member

o Prisoner/inmate/detainee

o Researcher

o Seeking help for self

o Seeking help for someone else

o Student: K-12

o Student: Post-secondary

o Other (please specify) _



2. Did you find the publication(s) you were looking for?

o Yes

o No


If you did not find the publication(s) you were looking for, please explain: [Open text field]



3. On what additional topics, if any, would you like NIMH to offer publications? [Open text field]



4. Overall, how satisfied are you with the NIMH publication ordering website?

o Very satisfied

o Satisfied

o Somewhat satisfied

o Unsatisfied

o Very unsatisfied


If you selected “Unsatisfied” or “Very unsatisfied,” please explain: [Open text field]



5. Ongoing feedback from our customers is very important to us. May we contact you in the future to get your additional feedback on our materials?

o Yes

o No


If Yes, please provide the best email to reach you: [open text field]



6. Do you have additional comments about the NIMH publication ordering website? [Open text field]



Thank you for your time and participation!

[“Submit” button]

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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 Created2021-02-19

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