OPP Annual Meeting Assessment fast track

Request for OMB Clearance2 - Collection of Routine Customer Feedback (OPP Annual Meeting Assessment).docx

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

OPP Annual Meeting Assessment fast track

OMB: 0925-0648

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

Shape1

TITLE OF INFORMATION COLLECTION:

National Institute of Mental Health (NIMH) Outreach Partnership Program Annual Meeting Assessment Form

PURPOSE:


The NIMH Outreach Partnership Program is a nationwide initiative through which NIMH supports 55 Outreach Partners - primarily nonprofit mental health organizations representing every state, the District of Columbia, and Puerto Rico - to disseminate NIMH-supported research and educational resources through their mental health outreach and education efforts. Attendance at the annual program meeting is required of all Outreach Partners. Information is collected to gauge the effectiveness of the meeting and to receive input in planning for subsequent meetings.


DESCRIPTION OF RESPONDENTS:


Representatives of NIMH Outreach Partner organizations, mostly nonprofit mental health outreach, education and advocacy organizations work at the state and local levels to educate the public and other key stakeholders about mental health.


TYPE OF COLLECTION: (Check one)

Shape2 Shape3 Customer Comment Card/Complaint Form 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: Rajni Agarwal, Office of Science Policy, Planning, and Communications, NIMH





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

Shape4 Shape5 Personally Identifiable Information:

  1. Is personally identifiable information (PII) collected? Yes No


  1. Shape6 Shape7 If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? Yes No


  1. Shape8 Shape9 If applicable, has a System or Records Notice been published? N/A Yes No


Gifts or Payments:

Shape11 Shape10 Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? Yes


ESTIMATED BURDEN HOURS and COSTS


Category of Respondent

No. of Respondents

No. of Responses per Respondent

Time per Response (in hours)

Total Burden Hours

Private Sector - Sponsored Outreach Partners, Non-sponsored National Partners and others

82

1

10/60

14






Totals

82

82


14


Category of Respondent

Total Burden

Hours

Hourly Wage Rate*

Total Burden

Cost

Private Sector - Sponsored Outreach Partners, Non-sponsored National Partners and others

14

$20.36/hour

$285.04





Totals

14


$285.04

*Cite source per bls.gov if applicable - https://www.bls.gov/oes/current/oes211094.htm.


Staff

Grade/Step

Salary

% of Effort

Fringe (if applicable)

Total Cost

to Gov’t

Federal Oversight






NIMH Outreach Partnership Program Liaison

GS-13/5

$52.66/hour

4 hours


$210.64

Contractor Cost






Event Coordinator


$30.41/hour

1 hour


$30.41

Travel






Other Cost






TOTAL





$241.05

FEDERAL COST: The estimated annual cost to the Federal government is: $241.05

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?


Shape12 Shape13 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 targeted respondents represent NIMH Outreach and National Partner organizations and selected NIMH staff.



Administration of the Instrument

  1. Shape14 How will you collect the information? (Check all that apply) Web-based or other forms of Social Media Telephone

In-person Mail

Other, Explain


  1. Shape15 Shape16 Will interviewers or facilitators be used? Yes


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 Created2021-05-03

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