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

Forms and Documents

Document Name	Status
Form 1 Opportunities for Extramural Collaborations at the NIH Clinical Center (U01) Customer Satisfaction Survey Form and Instruction	New
Form 1 Data Sharing for Demographic Research (DSDR) Customer Satisfaction Survey Form and Instruction	New
Form 6 NICHD Postpartum Depression (PPD) Focus Groups Form and Instruction	New
Form 1 Nurses' Continuing Education Program on Sudden Infant Death Syndrome (SIDS)--Customer Satisfaction Survey Form and Instruction	New
Form 1 Safe to Sleep Campaign Focus Groups with the Breastfeeding/Lactation Support Community Form and Instruction	New
Form 2 Non-Medically Indicated Induction Prior to 39 Weeks of Gestation Focus Groups Form and Instruction	New
Form 2 Back to Sleep Brand Identity Testing Form and Instruction	New
Form 1 Back to Sleep Brand Identity Testing Form and Instruction	New
Form 1 Back to Sleep Brand Identity Testing Form and Instruction	New
Generic_Clearance_Submission_Template[1].doc Supplementary Document	2011-10-24
generic_qualitative_feedback_NICHD_ Part B only.docx Supporting Statement B	2011-10-18
SSA generic_qualitative_feedback_NICHD_8-10-11[1].docx Supporting Statement A	2011-10-18

IC Document Collections

IC ID	Document Title	Status
212869	Opportunities for Extramural Collaborations at the NIH Clinical Center (U01) Customer Satisfaction Survey Form and Instruction	New
211191	Data Sharing for Demographic Research (DSDR) Customer Satisfaction Survey Form and Instruction	New
209998	NICHD Postpartum Depression (PPD) Focus Groups Form and Instruction	New
209640	Nurses' Continuing Education Program on Sudden Infant Death Syndrome (SIDS)--Customer Satisfaction Survey Form and Instruction	New
208131	Safe to Sleep Campaign Focus Groups with the Breastfeeding/Lactation Support Community Form and Instruction	New
201950	Non-Medically Indicated Induction Prior to 39 Weeks of Gestation Focus Groups Form and Instruction	New
201164	Back to Sleep Brand Identity Testing Form and Instruction	New
200993	Back to Sleep Brand Identity Testing Form and Instruction	New
200805	Back to Sleep Brand Identity Testing Form and Instruction	New

ICR Details

OMB Control No: 0925-0643	ICR Reference No: 201110-0925-003
Status: Historical Active	Previous ICR Reference No: 201110-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NICHD)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/31/2011
	Date Received in OIRA: 10/24/2011
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.”

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2014	36 Months From Approved
Responses	45,600	0	0
Time Burden (Hours)	14,850	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (NIH) to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with NICHD's programs.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Customer Satisfaction
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 245	12/22/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 55398	09/07/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 9

IC Title	Form No.	Form Name
Back to Sleep Brand Identity Testing	1, 2	Screener ,   Moderators Guide
NICHD Postpartum Depression (PPD) Focus Groups	1, 2, 3, 4, 5, 6, 7	Recruitment Screener Mom telephone focus group ,   Recruitment Screener PPD Moms ,   Recruitment Screener Fathers ,   Recruitment Screener Mom In-person Focus Group ,   Moderator Guide Fathers ,   Moderators Guide general mom ,   Moderators Guide PPD Moms
Non-Medically Indicated Induction Prior to 39 Weeks of Gestation Focus Groups	2, 1, 3	Focus Group fathers ,   Screener ,   Pregnant Women
Back to Sleep Brand Identity Testing	2, 1	Screener ,   Moderators Guide
Data Sharing for Demographic Research (DSDR) Customer Satisfaction Survey	1	DSDR Screenshots
Back to Sleep Brand Identity Testing	2, 1	Moderators Guide ,   Screener
Nurses' Continuing Education Program on Sudden Infant Death Syndrome (SIDS)--Customer Satisfaction Survey	1	Nurse CE Program Survey
Opportunities for Extramural Collaborations at the NIH Clinical Center (U01) Customer Satisfaction Survey	1	Online customer satisfaction survey screen shots
Safe to Sleep Campaign Focus Groups with the Breastfeeding/Lactation Support Community	1, 2, 3, 4	Recruitment Screener for Breastfeeding Women ,   Moderator's Guide for Breastfeeding Women ,   Recruitment Screener for Pregnant Women ,   Moderator's Guide for Pregnant Women

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	45,600	0	0	45,600	0	0
Annual Time Burden (Hours)	14,850	0	0	14,850	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new ICR.

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Annual Cost to Federal Government: $446,545

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/24/2011

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