Fast Track Memo

Request for Approval under the “Voluntary Surveys in the Health Resources and Services Administration” (OMB Control Number: 0906-0084)

TITLE OF INFORMATION COLLECTION: Division of Practitioner Data Bank (DPDB) Webinar Feedback and Satisfaction Surveys

PURPOSE: The purpose of this information collection request is to assess participant training needs and measure satisfaction with various training and educational webinars offered by DPDB. The surveys will collect 1) requests for questions to be answered during the webinar and 2) post-webinar feedback on participant satisfaction.

Survey feedback will be summarized and used to identify webinar strengths and weaknesses and to identify education and outreach strategies, modalities, and content that participants find most useful. Feedback and satisfaction data will also be used to inform a continuous quality improvement framework to test and refine education and outreach strategies.

DESCRIPTION OF RESPONDENTS: National Practitioner Data Bank (NPDB) Users and Stakeholders

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: David Loewenstein, Division Director

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

Personally Identifiable Information:

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

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

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden Hours Total
NPDB Users and Stakeholders	2,400	5 minutes	200
Totals	2,400		200

FEDERAL COST:

The estimated annual cost to the federal government is: $4,713 (40 hrs x $78.56/hr. x 1.5 overhead adjustment for one GS-15, Step 1 DPDB staff member)

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?

The survey is voluntary. The universe of respondents is webinar registrants.

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.