fast track template of CSS Submission 2012v2

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number:0925-0648 exp. 01/31/15)

T ITLE OF INFORMATION COLLECTION: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Customer Satisfaction Survey

PURPOSE: The survey will be mailed out to customers with every order placed for the duration of the survey timeframe to obtain feedback on the customer’s experience with the Clearinghouse and our materials. Our purpose is to obtain responses that provide us with information on which clearinghouse is most frequently contacted, the method in which the contact is made, the products or services received and their usefulness, and how frequently the customers are contacting the clearinghouses. Additionally, we would like to ascertain the quality of the customer’s experience in interacting with the clearinghouse by uncovering the helpfulness of the person they most recently communicated with and the speed with which they received either a response or their requested materials. This feedback will allow us to determine what, if any, changes need to be made to our current business practices as well as providing information on clearinghouse and publication popularity among customers.

DESCRIPTION OF RESPONDENTS: Individuals who are NIDDK customers and ordered NIDDK materials (can include persons form general population and representatives of the following: libraries, colleges and universities, schools, private medical practices, hospitals and health centers, businesses, media, consumers, unknown respondents, faith-based organizations, professional organizations, community based organizations, nonprofits, advocacy groups, state and local governments, Federal Government, NIDDK, NIDDK contractors).

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:_____Jody Nurik_________________________

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
Individuals	1800	2 minutes	60
Totals	1800	2 minutes	60

FEDERAL COST: The estimated annual cost to the Federal government is __$10,702__________

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 universe of potential respondents will be identified from the orders placed by customers for each reporting period. The sampling plan involves selecting a non-probability purposive sample of NIDDK customers to optimize the overall response rate. Specifically, customer satisfaction survey cards will be sent to all individuals who ordered NIDDK materials during the specified time period under study. This method was used under the previous OMB cleared survey and resulted in an average of 10-11% response rate.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[x ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [x ] No

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