Fast Track Memo

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0990 – 0379)

TITLE OF INFORMATION COLLECTION: HRSA Division of Transplantation (DoT) Concept Testing

PURPOSE: As a vital part of its ongoing mission, DoT produces educational and outreach materials on organ donation and transplantation for numerous audiences. DoT is seeking to garner feedback on new materials specifically designed to educate about living organ donation. Focus group responses will be used to shape and inform the final materials developed by DoT. If this information is not collected, vital feedback from customers will be unavailable, and DoT may develop and distribute materials that are confusing or not helpful.

DESCRIPTION OF RESPONDENTS: The collection of this information will be qualitative, voluntary, and non-controversial. Collection will be targeted to the opinions of consumers who support organ donation. There will be 10 focus groups total, including four groups representing the general public (each including at least one person who is Asian, Native Hawaiian/Other Pacific Islander, or American Indian/Alaska Native), two groups of African American adults, two groups of Spanish-speaking Hispanic adults, and two groups of adults over age 50. Participants in each group will represent a mix of genders and education levels.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software) [ ] Small Discussion Group

[X] 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: Lauren Darensbourg

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

Personally Identifiable Information:

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

2. If yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [X] 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? [X] Yes [] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden Hours Total
Individuals: General public	60	1.75 hours	105
Totals	60	1.75 hours	105

FEDERAL COST:

The estimated annual cost to the Federal Government is approximately $69,832.85 which includes 1) $60,000 in configuration and testing, and 2) and $9,832.85 in project management and oversight (5% from GS12 ($89,834) and 5% from GS13 ($106,823)).

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

Respondents will be selected by a third-party recruitment vendor using the screener. Respondents are not meant to represent a statistically significant sample of any particular target population. The vendor will recruit from their proprietary database of individuals who have agreed to take part in research studies.

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? [X] Yes [] No

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