fast track for Partnerships for Environmental Public Health (PEPH) Aware-Act-Use – Individuals/households

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: Partnerships for Environmental Public Health (PEPH) Aware-Act-Use – Individuals/households

PURPOSE:

The Partnerships for Environmental Health program produces webinars, podcasts, and a monthly newsletter. The purpose of these surveys is to assess user satisfaction with the products.

The three products are:

1. The PEPH Newsletters (https://www.niehs.nih.gov/research/supported/translational/peph/currentissue/index.cfm)

2. The PEPH Webinars (https://www.niehs.nih.gov/research/supported/translational/peph/webinars/index.cfm)

3. The PEPH Podcasts (https://www.niehs.nih.gov/research/supported/translational/peph/podcasts/index.cfm)

DESCRIPTION OF RESPONDENTS:

Individuals that receive or use the products will have the opportunity to complete the survey.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [x] 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:_Liam O’Fallon____________________________________

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, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [x] Yes [ ] No

3. If Applicable, has a System or Records Notice been published? [x] 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	No. of Respondents	No. of Responses per Respondent	Time per Response (in hours)	Total Burden Hours
Individuals of households	292	1	5/60	24
Totals	292	292		24

Category of Respondent	Total Burden Hours	Hourly Wage Rate*	Total Burden Cost
Individuals of households	24	$17.81	$ 427.44
Totals	24		$ 427.44

* This is the median hourly wage rate for “All Occupations” from the May 2016 National Occupational Employment and Wage Estimates for the United States: https://www.bls.gov/oes/current/oes_nat.htm#00-0000

FEDERAL COST: The estimated annual cost to the Federal government is $2140.00_

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Coordinator	13-9	$107,000.00	2%		$2140
Contractor Cost
Travel
Other Cost
Total					$2140.00

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?

We have a listserv that we can use to contact potential survey respondents. The listservs are relatively small (~3000). We will send the surveys to all members of the listserv, so we do not have a sampling plan. We expect a response rate between 10 and 20% for surveys on use of newsletters and podcasts and as high as 50% for webinar participants. Information on responses rates is wide and varied. The actual response rate may be greater (or lower) than our estimate.

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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