NLM LHC Cervigram Generic Clearance Request Form

NLM LHC Cervigram Generic Clearance Request Form.doc

Request for Generic Clearance to Conduct Voluntary Customer/Partner Surveys(NLM)

NLM LHC Cervigram Generic Clearance Request Form

OMB: 0925-0476

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SUBMISSION OF INFORMATION COLLECTION

UNDER GENERIC CLEARANCES



DATE OF REQUEST: 2/16/2010


SUB AGENCY (I/C): National Library of Medicine


TITLE: NLM CervigramFinder Physician Survey


GENERIC CLEARANCE UNDER OMB# ­ 0925-0476 EXP. DATE: 06/30/2012


ABSTRACT:

We request clearance for an in-person survey of physicians attending the 2010 biennial meeting of the American Society for Colposcopy and Cervical Pathology (ASCCP) in Las Vegas, Nevada from March 24 – 27, 2010. Paper copies of this survey will be placed in information bags provided to every registered attendee at the conference. Attendees will be asked to voluntarily complete the survey and return it to a designated booth manned by staff from the National Library of Medicine in the exhibit hall. No identifying or demographic information about the users will be collected.


The survey results will help determine the interest of specialized physicians in accessing the NLM CervigramFinder and Boundary Marking Tool, as well as determine the points of interest most relevant to work conducted by these specialists.














TOTAL ANNUAL BURDEN APPROVED: 3,600 hours


BURDEN USED TO DATE: 0000


BURDEN THIS REQUEST: 33.33 hours


IS RACE AND ETHNICITY DATA COLLECTED AS REQUIRED?

______YES __X__NO______N/A


OBLIGATION TO RESPOND:


X VOLUNTARY


______ REQUIRED TO OBTAIN OR RETAIN BENEFITS


______ MANDATORY


HOW WILL THIS SURVEY BE OFFERED?


_____ WEB SITE


_____ TELEPHONE INTERVIEW


_____ MAIL RESPONSE


X IN PERSON INTERVIEW


_____ OTHER: ___________________________________


CONTACT INFORMATION:


NAME: Sarah Ward


TELEPHONE NUMBER: 301-407-7722


EMAIL ADDRESS: saward@mail.nih.gov

File Typeapplication/msword
File TitleINFORMATION COLLECTION REQUEST FOR GENERIC CLEARANCES
Authorcurriem
Last Modified Bysharlipd
File Modified2010-02-17
File Created2010-02-17

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