NIHOMBuds_generic_clearance_2 (2)

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0925-0648)

T ITLE OF INFORMATION COLLECTION: NIH Office of the Ombudsman, Center for Cooperative Resolution, user feedback survey.

PURPOSE:

The NIH Office of the Ombudsman, Center for Cooperative Resolution (OO/CCR), Office of the Director, is a confidential, neutral, and independent resource providing informal assistance to NIH scientists, administrators, and staff at all levels in addressing work-related issues. The OO/CCR serves as a focal point for conflict resolution at NIH by (1) providing confidential, informal assistance to employees and managers in resolving work-related concerns and (2) developing and coordinating effective dispute resolution processes and procedures. The Office provides a variety of services and programs to address likely sources of conflict, such as interpersonal communication, performance appraisals, harassment, mentoring relationships, and scientific collaboration. In order to continually improve the services we provide to the NIH community, the Office would like to offer visitors the option of completing an anonymous feedback survey about their experiences working with our Office. The survey will be posted on the Office of the Ombudsman website. Visitors will be informed about the survey during the course of their work with the Office and will be able to choose whether to complete the survey.

DESCRIPTION OF RESPONDENTS:

As an NIH-wide survey instrument, we anticipate the respondents will include federal employees as well as 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: Samantha Levine-Finley, Associate Ombudsman /s/

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? [ ] Yes [x] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [x] 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	300	10/60	50 hrs.
Totals	300		50 hrs.

FEDERAL COST: The estimated annual cost to the Federal government is $5,125.

• Annual subscription to third-party online survey creation mechanism (SurveyGizmo): $675/year.

• Employee work time dedicated to survey creation and results reporting: est. $4,450 (approx. 0.05% FTE @ GS 13/1)

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? [ ] Yes [x] 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?

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

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