NIH fast track clearance request - NLM HMD Exhibition Survey

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0925-0648 exp 01/2015)

TITLE OF INFORMATION COLLECTION: Traveling Exhibition Host Survey

PURPOSE: This project will gather data from the past traveling exhibition hosts in order for the Exhibition Program to:

1. establish a baseline for types and levels of supplementary programs offered in conjunction with the NLM traveling exhibitions;

2. identify public programs that feature online exhibition and NLM resources; and

3. identify resource needs for supporting the host institution’s developing community programs in conjunction with the traveling exhibition display.

DESCRIPTION OF RESPONDENTS: The Traveling Exhibition Host Survey respondent are the institutions who have hosted or are scheduled to host one or more banner-style traveling exhibitions from the Exhibition Program at the National Library of Medicine (NLM) since January 2010.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software) [ ] Small Discussion Group

[] Focus Group [X] Other: Traveling Exhibition Host Survey sent via email and followed up with a phone call.

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.

Name: Jiwon Kim, Exhibition Program/HMD/LO/NLM_

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

Personally Identifiable Information:

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

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

3. If Applicable, has a System or Records Notice 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: The burden hours reflect estimating time needed by each respondent either for completing the paper survey or providing survey feedback at the time of the follow-up phone call. We estimate that reading and getting verbal response to the survey on the phone would take 5-10 minutes for many host institutions.

Category of Respondent	No. of Respondents	Participation Time	Burden
Individuals	250	30/60	125 hrs.
Totals			125 hrs.

FEDERAL COST: The estimated annual cost to the Federal government is: $1,600..

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?

Respondents are the traveling exhibition host institutions that have borrowed or are scheduled to borrow one or more banner-style traveling exhibitions from the Exhibition Program at the National Library of Medicine since 2010.

Administration of the Instrument

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

[ ] Web-based or other forms of Social Media

[X2] Telephone The Exhibition Program will conduct a follow-up phone call in order to confirm receipt of the email and the form by the past host institutions.

[ ] In-person

[ ] Mail

[X1] Other, Explain. The summary report form will be sent to the past host institutions via email initially.

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

Please make sure that all instruments, instructions and scripts are submitted with the request.

Attachment #1 – NLM HMD Traveling Exhibition Host Survey instrument

Attachment #2 - NLM HMD Traveling Exhibition Email Solicitation

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