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

Forms and Documents

Document Name	Status
Form 1 NIH Library Customer Satisfaction Survey Form	New
Form 1 Basic electronic survey to inform development of a nursing research brochure (NINR) Form and Instruction	New
Form 1 Workflow information Tracking System (WiTS) Focus Groups (OD) Form and Instruction	New
Form 1 NEI Health Focus Groups with New Audiences Ages 25-35 Form and Instruction	New
Form 1 NIMH Professional Coalition for Research Progress Meeting Assessment Form Form	New
Form 1 2018 NLM SIS Emerging Adults Health Needs Assessment Form and Instruction	New
Form 1 HMD 2018 Exhibition Program Web Usability Study Form	New
Form 1 Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Federal Government) Form	New
Form 1 Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (State, Local or Tribal) Form	New
Form 1 Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Private Sector) Form	New
Form 1 Partnerships for Environmental Public Health Program (PEPH) Aware-Act-Use Survey (Individuals/households) Form	New
Form 1 NCBI 2018 Genetics and Population Frequency Data Survey (NLM) Form	New
Form 1 NLM 2018 Public Libraries Association Survey Form	New
Form 1 NLM TOXNET 2018 Workshop Survey Form and Instruction	New
Form 1 DVR Animal Services Needs Assessment Form	New
Form 1 Outcomes of IDeA Core Optimization Administrative Supplements Form	New
Form 1 NLM NCBI 2018 Literature Resources Survey Form	New
Form 1 Medicine: NIH Mind the Gap Webinar Series Survey II Form	New
Form 1 NLM NCBI 2018 Representative Genomes Survey Form	New
Form 1 Human Resources Classification and Recruitment Documents System (HR CARDS) Survey Form	New
Form 1 Pediatric Patient Perception Survey (CC) Form and Instruction	New
Form 1 Benefits & Payroll Liaison Branch (BLPB) Customer Satisfaction Survey Form	New
Form 1 Forecasting Science Survey Form	New
Form 1 The NIH Director's Blog Readership Survey Form	New
Form 1 NIH Library Survey on Statistical Class Offerings Form	New
Form 1 ORF Workplace Aesthetic Survey (OD) Form and Instruction	New
Form 1 ODP Pathways to Prevention Survey II Form	New
Form 1 NLM AIDSource 2017 Survey Form	New
Form 1 OER Intercept survey Form	New
Form 1 NCBI Medical Genetics and Variation Web Resources 2017 Survey Form	New
Form 1 NLM Website Survey for Website Satisfaction Rating Form	New
Form 1 Ombudsman Services Feedback Survey Form and Instruction	New
Form 1 NCBI BLAST Web Services 2017 Survey Form	New
Form 1 Brother, You're on My Mind (BYOMM) After Action Report Form and Instruction	New
Form 1 Brother, You're on My Mind (BYOMM) Knowledge Attitudes and Believes Form Form and Instruction	New
Form 1 NIH Library Survey: Weekend Library Use Form and Instruction	New
Form 1 Children's Health Exposure Assessment Resource (CHEAR) Client Satisfaction Survey Form and Instruction	New
Form 1 NIH Events Management – Video Production Survey Form and Instruction	New
Form 1 NIH Events Management – Scheduling Services Survey Form and Instruction	New
Form 1 NIH Events Management – Post Production Survey Form and Instruction	New
Form 1 NIH Events Management – Audio Visual Survey Form and Instruction	New
Form 1 Workplace and Organizational Performance Survey Form and Instruction	New
Form 1 The NIH Extramural Loan Repayment Programs: Online Customer Service Survey About the Application Technical Assistance Webinar Form and Instruction	New
Form 1 NCBI 2017 Sequence Database User Survey Form	New
Form 1 OHR Website Customer Satisfaction Survey Form	New
Form 1 Change Readiness Survey Form	New
Form 1 NLM NCBI ClinicalTrials.gov Website Usability Survey 2017 Form	New
Form 1 Office of Human Resources (OHR) Climate Survey Form	New
Form 1 NLM Survey for MedlinePlus Page Satisfaction Form	New
Form 1 DSSEM Application and Interview Satisfaction Survey Form and Instruction	New
Form 1 Customer Satisfaction with the Contribution of Site Visits to Assess Institutional Training Grant Applications (NIGMS) Form	New
Form 1 NCBI 2017 Website User Survey Form	New
Form 1 CSR Poll on Grant Award Productivity using the Relative Citation Ratio (RCR) Form	New
Form 1 NLM Main Website Satisfaction Survey Form	New
Form 1 Chair Survey Form and Instruction	New
Form 1 NLM NCBI Microbe Conference Survey Form and Instruction	New
Form 1 NLM NCBI ClinicalTrials.gov Website User Survey Form	New
Form 1 Medical Arts Branch (MAB) Services Survey Form and Instruction	New
Form 1 Pathways for Teamwork Customer Satisfaction Interviews Form	New
Form 1 DIS Immigration Conference Evaluation Survey Form	New
Form 1 CTSU Website Customer Satisfaction Surveys Form and Instruction	New
Form 1 Data and Safety Monitoring Meeting Evaluation Form and Instruction	New
Form 1 2017 GSRP Website Survey Applicant Form	New
Form 1 2017 Graduate Student Recruitment Program (GSRP) Form	New
Form 1 NCI OSFM Shuttle Service Survey Form and Instruction	New
Form 1 NCI OSFM Conference Room Services Survey Form and Instruction	New
Form 1 NCI OSFM Relocation Survey- Lab Form	New
Form 1 NCI OSFM Fitness Center Survey Form	New
Form 1 NCI OFSM Relocation Survey - Office Form	New
Form 1 NCI OSFM Express Services Survey Form	New
Form 1 NCI OSFM Small Little Job (SLJ) Survey Form	New
Form 1 "The Nuts and Bolts of Group Randomized Trials" Participant Feedback Survey Form and Instruction	New
Form 1 NIH Training Center Meeting Facilitation Survey Form and Instruction	New
Form 1 DVR Customer Service Survey - Animal Transportation Services Form	New
Form 1 DVR Cutomer Service Survey - Animal Services Form	New
Form 1 DVR Customer Service Survey - Animal Procurement Form	New
Form 1 NLM ClinVar 2017 Website User Survey Form and Instruction	New
Form 1 Participant Feedback on 2017 NIH Common Fund 2017 Stimulating Peripheral Activity to Relieve Conditions (SPARC) Research Program Annual Awardee Meeting Form and Instruction	New
Form 1 NLM MedlinePlus Page Google Survey Satisfaction Rating Form and Instruction	New
Form 1 NLM Library Operations Customer Satisfaction Survey Form and Instruction	New
Form 1 Workflow Information Tracking System (WiTS) Focus Groups Form	New
Form 1 NLM NCBI Gene Resources Website Survey Form and Instruction	New
Form 1 Drupal Implementation and Content Enhancement (DICE) Focus Groups Form	New
Form 1 National Institute of Mental Health (NIMH) Office of the Director and Extramural Programs Workforce Resource Analysis Form and Instruction	New
Form ODS Interview Guid Analytical Methods and Reference Materials Program Stakeholder Interviews (For Profit) Form and Instruction	New
Form 1 Analytical Methods and Reference Materials Program Stakeholder Interviews (Not for Profit) Form and Instruction	New
Form 1 NLM DOCLINE Customer Service Survey Form and Instruction	New
Form 1 Patient Perception Survey (CC) Form and Instruction	New
Form 1 DrugAbuse.gov Website Feedback Survey Form and Instruction	New
Form 1 National Institute of Mental Health (NIMH) Employee Engagement Survey Form and Instruction	New
Form 1 NLM Google Survey for MedlinePlus Page Satisfaction Rating Form and Instruction	New
Form 1 Participant Feedback on 2016 NIH Common Fund High-Risk, High-Reward Research Symposium Form and Instruction	New
Form 1 NLM Genetic Home Reference User Study Form and Instruction	New
Form 1 LIS User Survey of NLM Resources Form and Instruction	New
Form 1 NLM GHR User Study Screening Survey Form and Instruction	New
Form 1 Future Research Leaders Conference –Communication Survey Form and Instruction	New
Form 1 2016 Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Principle Investigators' (PI) Meeting Post-Conference Evaluation Survey Form and Instruction	New
Form 1 The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form C Form and Instruction	New
Form 1 The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form B Form and Instruction	New
Form 1 The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form A Form and Instruction	New
Form 1 Pragmatic & Group-Randomized Trials (GRT) in Public Health & Medicine Participant Feedback Survey: Parts 1-7 Form	New
Form 1 NLM ToxTutor User Survey Form and Instruction	New
Form 1 The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Award Applicants Form and Instruction	New
Form 1 The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Mentors Form and Instruction	New
Form 1 The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Recommenders/Referees Form and Instruction	New
Form 1 The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Institutional Business Officials (IBOs) Form and Instruction	New
Form 1 NLM 4 Caregivers User Survey Form and Instruction	New
Form 1 LRP Qualitative Research Form and Instruction	New
Form 1 LRP Ambassador Feedback Form and Instruction	New
Form 1 CSR Website Redesign Novice Applicants & Reviewer Interviews Form	New
Form 1 NLM MedlinePlus RML User Survey Form	New
Form 1 2016 HHS Learning Portal (LMS) User Survey Form	New
Form 1 NLM NCBI CCDS User Survey Form	New
Form 1 OM All Hands Meeting Survey Form and Instruction	New
Form 1 Health Information Technology Patient Satisfaction Survey (CC) Form and Instruction	New
Form 1 NLM Traveling Exhibition Visitor Study Form and Instruction	New
Form 1 Influenza Vaccine Survey Form	New
Form 1 NLM ClinVar 2016 User Survey Form	New
Form 1 National Institute of Dental and Craniofacial Research Focus Group Study Form and Instruction	New
Form 1 HHS SBIR/STTR Showcase Conference Feedback Form	New
Form 1 Future Research Leaders Conference Survey Form and Instruction	New
Form 1 NIH Office of Intramural Training & Education (OITE) – Community College Day Feedback Form	New
Form 1 NIH Office of Intramural Training & Education (OITE) – Graduate & Professional School Fair Feedback Form	New
Form 1 NIH Native American Visit Week Feedback Form and Instruction	New
Form 1 NHLBI's Health Information Center (HIC) Form and Instruction	New
Form 1 IntraHR Website Customer Satisfaction Survey Form and Instruction	New
Form 1 National Institute of Dental and Craniofacial Research (NIDCR) Website Usability Study Form and Instruction	New
Form 1 Customer Feedback on NIH's Targeted Guidance for New Investigators Form and Instruction	New
Form 1 Career Symposium Feedback Form and Instruction	New
Form 1 NIH Office of Intramural Training & Education (OITE) – Management Boot Camp Feedback Form and Instruction	New
Form 1 NIH Office of Intramural Training & Education (OITE) – General Feedback Form Form and Instruction	New
Form 1 NLM MedlinePlus Connect Customer Survey Form and Instruction	New
Form 1 NLM Project SHARE website assessment Form and Instruction	New
Form 1 ODP Pathways to Prevention Survey -For Profits Form and Instruction	New
Form 1 ODP Pathways to Prevention Survey -Not For Profits Form and Instruction	New
Form 1 Awardees Feedback Survey on NHLBI PAR-10-005 and PAR-13-002, NHLBI Clinical Trial Pilot Studies (R34) Form and Instruction	New
Form 1 Shuttle Bus Survey for Fishers Lane Form and Instruction	New
Form 1 NIH Research Training Institutes (RTIs) Customer Satisfaction Surveys Form and Instruction	New
Form 1 NLM NCBI GRC Website User Survey Form and Instruction	New
Form 1 NLM NCBI Health Resources Survey Form and Instruction	New
Form 1 NLM MedlinePlus Website Usability Testing Form and Instruction	New
Form 2 US-Japan Cooperative Medical Sciences Program (USJCMSP) 50th Anniversay and 18th International Conference on Emerging Infectious Diseases in the Pacific Rim Form and Instruction	New
Form 1 Traveling Exhibition Host Survey Form and Instruction	New
Form 1 The NIH Director's Blog Readership Survey Form and Instruction	New
Form 1 WiTS Climate Survey 2015 Form and Instruction	New
Form 1 NLM Reading Rooms Satisfaction Survey Form and Instruction	New
Form 1 Medicine: Mind the Gap NIH Seminar Series Survey-Not-For-Profits Form and Instruction	New
Form 1 Medicine: Mind the Gap NIH Seminar Series Survey-For Profits Form and Instruction	New
Form 1 NIMH Information Resource Center (IRC) Customer Satisfaction Surveys for Email Information Services, Online Publications Ordering Services and Telephone Services Form and Instruction	New
Form 1 NIMH Website Survey Form and Instruction	New
Form 1 KAI Annual Client Satisfaction Survey Form and Instruction	New
Form 1 HR Systems Support (HRSS) Customer Satisfaction Survey Form and Instruction	New
Form 1 Information Management Team (IMT) Web Intercept Survey Form and Instruction	New
Form 1 NLM Customer Service Satisfaction Survey Form and Instruction	New
Form 1 Variation Resources Survey Form and Instruction	New
Form 1 Usability testing for PHPartners.org website Form and Instruction	New
Form 1 NCCIH Customer Service Data Collection Form and Instruction	New
Form 1 Office of Human Resources (OHR) Training Survey Form and Instruction	New
Form 1 The Annual NIH Pain Consortium Symposium Feedback (Not For Profit) Form and Instruction	New
Form 1 The Annual NIH Pain Consortium Symposium Feedback (For Profit) Form and Instruction	New
Form 1 Office of Human Resources (OHR) Pulse Survey Form and Instruction	New
Form 1 Educational Game Focus Group Form and Instruction	New
Form 1 2015 NIH Single Cell Analysis Investigators Meeting Survey Form and Instruction	New
Form 1 PubMed Search User Survey Form and Instruction	New
Form 1 Qualitative Research to Explore Barriers and Facilitators for LRP Ambassadors to Promote the NIH Loan Repayment Programs Form and Instruction	New
Form 1 Community Health Maps Project User Survey Form and Instruction	New
Fast Track Template.doc Supplementary Document	2015-01-28
SSB_0925-0648_NIH Wide Fast Track Extension.docx Supporting Statement B	2015-01-28
SSA Generic NIHWide Fast Track1.docx Supporting Statement A	2015-01-28

IC Document Collections

IC ID	Document Title	Status
230704	NIH Library Customer Satisfaction Survey Form	New
230693	Basic electronic survey to inform development of a nursing research brochure (NINR) Form and Instruction	New
230689	Workflow information Tracking System (WiTS) Focus Groups (OD) Form and Instruction	New
230574	NEI Health Focus Groups with New Audiences Ages 25-35 Form and Instruction	New
230549	NIMH Professional Coalition for Research Progress Meeting Assessment Form Form	New
230502	2018 NLM SIS Emerging Adults Health Needs Assessment Form and Instruction	New
230499	HMD 2018 Exhibition Program Web Usability Study Form	New
230409	Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Federal Government) Form	New
230407	Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (State, Local or Tribal) Form	New
230406	Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Private Sector) Form	New
230405	Partnerships for Environmental Public Health Program (PEPH) Aware-Act-Use Survey (Individuals/households) Form	New
230393	NCBI 2018 Genetics and Population Frequency Data Survey (NLM) Form	New
230245	NLM 2018 Public Libraries Association Survey Form	New
230205	NLM TOXNET 2018 Workshop Survey Form and Instruction	New
230048	DVR Animal Services Needs Assessment Form	New
230014	Outcomes of IDeA Core Optimization Administrative Supplements Form	New
230013	NLM NCBI 2018 Literature Resources Survey Form	New
229947	Medicine: NIH Mind the Gap Webinar Series Survey II Form	New
229825	NLM NCBI 2018 Representative Genomes Survey Form	New
229776	Human Resources Classification and Recruitment Documents System (HR CARDS) Survey Form	New
229752	Pediatric Patient Perception Survey (CC) Form and Instruction	New
229487	Benefits & Payroll Liaison Branch (BLPB) Customer Satisfaction Survey Form	New
229458	Forecasting Science Survey Form	New
229455	The NIH Director's Blog Readership Survey Form	New
229385	NIH Library Survey on Statistical Class Offerings Form	New
229190	ORF Workplace Aesthetic Survey (OD) Form and Instruction	New
229113	ODP Pathways to Prevention Survey II Form	New
229104	NLM AIDSource 2017 Survey Form	New
229073	OER Intercept survey Form	New
228994	NCBI Medical Genetics and Variation Web Resources 2017 Survey Form	New
228776	NLM Website Survey for Website Satisfaction Rating Form	New
228700	Ombudsman Services Feedback Survey Form and Instruction	New
228637	NCBI BLAST Web Services 2017 Survey Form	New
228636	Brother, You're on My Mind (BYOMM) After Action Report Form and Instruction	New
228634	Brother, You're on My Mind (BYOMM) Knowledge Attitudes and Believes Form Form and Instruction	New
228615	NIH Library Survey: Weekend Library Use Form and Instruction	New
228545	Children's Health Exposure Assessment Resource (CHEAR) Client Satisfaction Survey Form and Instruction	New
228342	NIH Events Management – Video Production Survey Form and Instruction	New
228341	NIH Events Management – Scheduling Services Survey Form and Instruction	New
228340	NIH Events Management – Post Production Survey Form and Instruction	New
228339	NIH Events Management – Audio Visual Survey Form and Instruction	New
228336	Workplace and Organizational Performance Survey Form and Instruction	New
228325	The NIH Extramural Loan Repayment Programs: Online Customer Service Survey About the Application Technical Assistance Webinar Form and Instruction	New
228233	NCBI 2017 Sequence Database User Survey Form	New
228024	OHR Website Customer Satisfaction Survey Form	New
227960	Change Readiness Survey Form	New
227851	NLM NCBI ClinicalTrials.gov Website Usability Survey 2017 Form	New
227845	Office of Human Resources (OHR) Climate Survey Form	New
227759	NLM Survey for MedlinePlus Page Satisfaction Form	New
227714	DSSEM Application and Interview Satisfaction Survey Form and Instruction	New
227642	Customer Satisfaction with the Contribution of Site Visits to Assess Institutional Training Grant Applications (NIGMS) Form	New
227452	NCBI 2017 Website User Survey Form	New
227241	CSR Poll on Grant Award Productivity using the Relative Citation Ratio (RCR) Form	New
227102	NLM Main Website Satisfaction Survey Form	New
227077	Chair Survey Form and Instruction	New
226938	NLM NCBI Microbe Conference Survey Form and Instruction	New
226886	NLM NCBI ClinicalTrials.gov Website User Survey Form	New
226868	Medical Arts Branch (MAB) Services Survey Form and Instruction	New
226628	Pathways for Teamwork Customer Satisfaction Interviews Form	New
226567	DIS Immigration Conference Evaluation Survey Form	New
226437	CTSU Website Customer Satisfaction Surveys Form and Instruction	New
226348	Data and Safety Monitoring Meeting Evaluation Form and Instruction	New
226276	2017 GSRP Website Survey Applicant Form	New
226275	2017 Graduate Student Recruitment Program (GSRP) Form	New
226261	NCI OSFM Shuttle Service Survey Form and Instruction	New
226259	NCI OSFM Conference Room Services Survey Form and Instruction	New
226257	NCI OSFM Relocation Survey- Lab Form	New
226256	NCI OSFM Fitness Center Survey Form	New
226246	NCI OFSM Relocation Survey - Office Form	New
226245	NCI OSFM Express Services Survey Form	New
226231	NCI OSFM Small Little Job (SLJ) Survey Form	New
226166	"The Nuts and Bolts of Group Randomized Trials" Participant Feedback Survey Form and Instruction	New
226141	NIH Training Center Meeting Facilitation Survey Form and Instruction	New
226135	DVR Customer Service Survey - Animal Transportation Services Form	New
226134	DVR Cutomer Service Survey - Animal Services Form	New
226016	DVR Customer Service Survey - Animal Procurement Form	New
226014	NLM ClinVar 2017 Website User Survey Form and Instruction	New
225739	Participant Feedback on 2017 NIH Common Fund 2017 Stimulating Peripheral Activity to Relieve Conditions (SPARC) Research Program Annual Awardee Meeting Form and Instruction	New
225540	NLM MedlinePlus Page Google Survey Satisfaction Rating Form and Instruction	New
225479	NLM Library Operations Customer Satisfaction Survey Form and Instruction	New
225379	Workflow Information Tracking System (WiTS) Focus Groups Form	New
225298	NLM NCBI Gene Resources Website Survey Form and Instruction	New
225281	Drupal Implementation and Content Enhancement (DICE) Focus Groups Form	New
225233	National Institute of Mental Health (NIMH) Office of the Director and Extramural Programs Workforce Resource Analysis Form and Instruction	New
225201	Analytical Methods and Reference Materials Program Stakeholder Interviews (For Profit) Form and Instruction	New
225198	Analytical Methods and Reference Materials Program Stakeholder Interviews (Not for Profit) Form and Instruction	New
225092	NLM DOCLINE Customer Service Survey Form and Instruction	New
225091	Patient Perception Survey (CC) Form and Instruction	New
224947	DrugAbuse.gov Website Feedback Survey Form and Instruction	New
224929	National Institute of Mental Health (NIMH) Employee Engagement Survey Form and Instruction	New
224925	NLM Google Survey for MedlinePlus Page Satisfaction Rating Form and Instruction	New
224889	Participant Feedback on 2016 NIH Common Fund High-Risk, High-Reward Research Symposium Form and Instruction	New
224887	NLM Genetic Home Reference User Study Form and Instruction	New
224855	LIS User Survey of NLM Resources Form and Instruction	New
224763	NLM GHR User Study Screening Survey Form and Instruction	New
224737	Future Research Leaders Conference –Communication Survey Form and Instruction	New
224736	2016 Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Principle Investigators' (PI) Meeting Post-Conference Evaluation Survey Form and Instruction	New
224690	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form C Form and Instruction	New
224689	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form B Form and Instruction	New
224687	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form A Form and Instruction	New
224454	Pragmatic & Group-Randomized Trials (GRT) in Public Health & Medicine Participant Feedback Survey: Parts 1-7 Form	New
224452	NLM ToxTutor User Survey Form and Instruction	New
224420	Workstyle Survey Other-Survey Email	New
224383	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Award Applicants Form and Instruction	New
224382	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Mentors Form and Instruction	New
224381	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Recommenders/Referees Form and Instruction	New
224380	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Institutional Business Officials (IBOs) Form and Instruction	New
224307	NLM 4 Caregivers User Survey Form and Instruction	New
224162	LRP Qualitative Research Form and Instruction	New
224159	LRP Ambassador Feedback Form and Instruction	New
223962	CSR Website Redesign Novice Applicants & Reviewer Interviews Form	New
223918	NLM MedlinePlus RML User Survey Form	New
223902	2016 HHS Learning Portal (LMS) User Survey Form	New
223817	NLM NCBI CCDS User Survey Form	New
223717	OM All Hands Meeting Survey Form and Instruction	New
223699	Health Information Technology Patient Satisfaction Survey (CC) Form and Instruction	New
223262	NLM Traveling Exhibition Visitor Study Form and Instruction	New
223254	Influenza Vaccine Survey Form	New
223099	NLM ClinVar 2016 User Survey Form	New
222516	Online Customer Service Survey About The Application Technical Assistance Webinar Other-Invitation Email	New
222437	National Institute of Dental and Craniofacial Research Focus Group Study Form and Instruction	New
222338	HHS SBIR/STTR Showcase Conference Feedback Form	New
222336	Future Research Leaders Conference Survey Form and Instruction	New
222332	NIH Office of Intramural Training & Education (OITE) – Community College Day Feedback Form	New
222098	NIH Office of Intramural Training & Education (OITE) – Graduate & Professional School Fair Feedback Form	New
222047	NIH Native American Visit Week Feedback Form and Instruction	New
221890	NHLBI's Health Information Center (HIC) Form and Instruction	New
221727	IntraHR Website Customer Satisfaction Survey Form and Instruction	New
221685	National Institute of Dental and Craniofacial Research (NIDCR) Website Usability Study Form and Instruction	New
221575	Customer Feedback on NIH's Targeted Guidance for New Investigators Form and Instruction	New
221359	Career Symposium Feedback Form and Instruction	New
221247	NIH Office of Intramural Training & Education (OITE) – Management Boot Camp Feedback Form and Instruction	New
221149	NIH Office of Intramural Training & Education (OITE) – General Feedback Form Form and Instruction	New
220938	NLM MedlinePlus Connect Customer Survey Form and Instruction	New
220783	NLM Project SHARE website assessment Form and Instruction	New
220632	ODP Pathways to Prevention Survey -For Profits Form and Instruction	New
220631	ODP Pathways to Prevention Survey -Not For Profits Form and Instruction	New
220346	Awardees Feedback Survey on NHLBI PAR-10-005 and PAR-13-002, NHLBI Clinical Trial Pilot Studies (R34) Form and Instruction	New
220178	Shuttle Bus Survey for Fishers Lane Form and Instruction	New
219530	NIH Research Training Institutes (RTIs) Customer Satisfaction Surveys Form and Instruction	New
219370	NLM NCBI GRC Website User Survey Form and Instruction	New
219201	NLM NCBI Health Resources Survey Form and Instruction	New
219199	NLM MedlinePlus Website Usability Testing Form and Instruction	New
219194	US-Japan Cooperative Medical Sciences Program (USJCMSP) 50th Anniversay and 18th International Conference on Emerging Infectious Diseases in the Pacific Rim Form and Instruction	New
219124	Traveling Exhibition Host Survey Form and Instruction	New
219012	The NIH Director's Blog Readership Survey Form and Instruction	New
219000	WiTS Climate Survey 2015 Form and Instruction	New
218992	NLM Reading Rooms Satisfaction Survey Form and Instruction	New
218941	Medicine: Mind the Gap NIH Seminar Series Survey-Not-For-Profits Form and Instruction	New
218939	Medicine: Mind the Gap NIH Seminar Series Survey-For Profits Form and Instruction	New
218616	NIMH Information Resource Center (IRC) Customer Satisfaction Surveys for Email Information Services, Online Publications Ordering Services and Telephone Services Form and Instruction	New
218505	NIMH Website Survey Form and Instruction	New
218063	KAI Annual Client Satisfaction Survey Form and Instruction	New
218050	HR Systems Support (HRSS) Customer Satisfaction Survey Form and Instruction	New
217979	Information Management Team (IMT) Web Intercept Survey Form and Instruction	New
217974	NLM Customer Service Satisfaction Survey Form and Instruction	New
217821	Variation Resources Survey Form and Instruction	New
217582	Usability testing for PHPartners.org website Form and Instruction	New
217316	NCCIH Customer Service Data Collection Form and Instruction	New
217040	Office of Human Resources (OHR) Training Survey Form and Instruction	New
217029	The Annual NIH Pain Consortium Symposium Feedback (Not For Profit) Form and Instruction	New
217028	The Annual NIH Pain Consortium Symposium Feedback (For Profit) Form and Instruction	New
216455	Office of Human Resources (OHR) Pulse Survey Form and Instruction	New
216184	Educational Game Focus Group Form and Instruction	New
216146	2015 NIH Single Cell Analysis Investigators Meeting Survey Form and Instruction	New
216076	PubMed Search User Survey Form and Instruction	New
215724	Qualitative Research to Explore Barriers and Facilitators for LRP Ambassadors to Promote the NIH Loan Repayment Programs Form and Instruction	New
215637	Community Health Maps Project User Survey Form and Instruction	New

ICR Details

OMB Control No: 0925-0648	ICR Reference No: 201501-0925-004
Status: Historical Active	Previous ICR Reference No: 201112-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/04/2015
	Date Received in OIRA: 01/29/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2018	36 Months From Approved	03/31/2015
Responses	759,000	0	759,000
Time Burden (Hours)	148,074	0	148,074
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable the National Institutes of Health 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 the agency's programs.

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Authorizing Statute(s): None

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 69500	11/21/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 4934	01/29/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 168

IC Title	Form No.	Form Name
The NIH Director's Blog Readership Survey	1	NIH Blog Survey
US-Japan Cooperative Medical Sciences Program (USJCMSP) 50th Anniversay and 18th International Conference on Emerging Infectious Diseases in the Pacific Rim	1, 2	USJCP Meeting feedback form ,   USJCP Meeting screenshots
NLM ClinVar 2016 User Survey	1	NLM ClinVar 2016 User Survey Instrument
Online Customer Service Survey About The Application Technical Assistance Webinar	1	LRP Webinar Survey
NLM MedlinePlus RML User Survey	1	NLM Medline Plus RML User Survey Instrument
The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form B	1	LRP Survey for Applicants Form B- Screenshot
LIS User Survey of NLM Resources	1	NLM LIS User Survey Instrument
NCI OSFM Small Little Job (SLJ) Survey	1	Survey
NIH Training Center Meeting Facilitation Survey	1	NIHTC Training Evaluation- Meeting Facilitation
NCI OFSM Relocation Survey - Office	1	NCI OFSM Relocation Survey - Office Moves
NLM NCBI ClinicalTrials.gov Website User Survey	1	NLM NCBI CT.gov Website User Survey Instrument
DIS Immigration Conference Evaluation Survey	1	DIS Immigration Conference Evaluation Survey
Office of Human Resources (OHR) Climate Survey	1	2017 OHR Climate Survey
OER Intercept survey	1	OER Intercept Survey questions
Workflow information Tracking System (WiTS) Focus Groups (OD)	1	WiTS Focus Group
Variation Resources Survey	1	NLM Variation Resources User Survey
Medicine: Mind the Gap NIH Seminar Series Survey-For Profits	1	Customer Satisfaction Survey
Medicine: Mind the Gap NIH Seminar Series Survey-Not-For-Profits	1	Customer Satisfaction Survey
Community Health Maps Project User Survey	1	Survey Screenshots
KAI Annual Client Satisfaction Survey	1	KAI Annual Client Survey Printscreens
HR Systems Support (HRSS) Customer Satisfaction Survey	1	HRSS Survey
ODP Pathways to Prevention Survey -Not For Profits	1	Survey Screenshot
NIH Office of Intramural Training & Education (OITE) – General Feedback Form	2, 1	FEEDBACK ON AN OITE EVENT ,   CAREER SERVICES CENTER
National Institute of Dental and Craniofacial Research (NIDCR) Website Usability Study	1	Usability Test Questions
NIH Office of Intramural Training & Education (OITE) – Community College Day Feedback	1	OITE-OMBFT- Community College Day- Feedback Collection
National Institute of Dental and Craniofacial Research Focus Group Study	2, 1	NIDCR-FG Moderator Guide ,   NIDCR Focus Group Recruitment Screener
NLM 4 Caregivers User Survey	1	NLM 4 Caregivers 2016 User Survey Instrument
2016 HHS Learning Portal (LMS) User Survey	1	2016 HHS Learning Portal (LMS)
LRP Ambassador Feedback	1	LRP Ambassador Feedback
DrugAbuse.gov Website Feedback Survey	1	NIDA- Website Feedback Survey Screenshots
Analytical Methods and Reference Materials Program Stakeholder Interviews (For Profit)	ODS Interview Guide for AMRA Stakeholders	1
NLM Google Survey for MedlinePlus Page Satisfaction Rating	1	NLM MedlinePlus Google Survey Instrument
The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form A	1	LRP Survey for Applicants Form A- Screenshots
Pragmatic & Group-Randomized Trials (GRT) in Public Health & Medicine Participant Feedback Survey: Parts 1-7	1	MOOC Survey
"The Nuts and Bolts of Group Randomized Trials" Participant Feedback Survey	1	SurveyMonkey SBM Evaluation
NCI OSFM Shuttle Service Survey	1	NCI OSFM Shuttle Service Survey Instrument
Patient Perception Survey (CC)	2, 1	NIHAIP Survey Mock-up - NRC Health ,   NIHAOP Survey Mock-up - NRC Health
DVR Customer Service Survey - Animal Transportation Services	1	FY17 Animal Transportation Survey
Forecasting Science Survey	1	Outsell NIH Forecasting Science Survey
Pediatric Patient Perception Survey (CC)	1	NRC NIH IP P Survey
NCBI 2018 Genetics and Population Frequency Data Survey (NLM)	1	NCBI 2018 Genetics and Population Frequency Data instrument
Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Federal Government)	1	PEPH Aware-Act-Use
The Annual NIH Pain Consortium Symposium Feedback (For Profit)	1	Pain Survey
PubMed Search User Survey	1	NLM PubMed Search User Survey
Usability testing for PHPartners.org website	1	Survey Screenshot
The Annual NIH Pain Consortium Symposium Feedback (Not For Profit)	1	Pain Survey
HHS SBIR/STTR Showcase Conference Feedback	1	HHS SBIR Showcase Event Feedback Form
NIH Native American Visit Week Feedback	1	Survey Instrument
CSR Website Redesign Novice Applicants & Reviewer Interviews	2, 1	Applicant survey ,   Reviewer questions
OM All Hands Meeting Survey	1	OM All Hands Survey
The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form C	1	LRP Survey for Applicants Form C-Screenshots
2017 Graduate Student Recruitment Program (GSRP)	1	2107 GSRP Survey
Workplace and Organizational Performance Survey	1	Workplace Organizational Performance Survey
Brother, You're on My Mind (BYOMM) After Action Report	1	BYOMM After Action
NCBI BLAST Web Services 2017 Survey	1	NCBI BLAST Web Services 2017 Survey Instrument
NIH Library Survey on Statistical Class Offerings	1	NIH Stats Survey 2017
NIH Library Customer Satisfaction Survey	1	Desk Survey May 2018
DVR Animal Services Needs Assessment	1	DVR Needs Assessment Survey
2018 NLM SIS Emerging Adults Health Needs Assessment	2, 1	SIS Emerging Adults Focus Group survey instrument ,   SIS Emerging Adults Web Based Survey instrument
HMD 2018 Exhibition Program Web Usability Study	1	HMD 2018 Exhibition Web Usability Study instrument
NCCIH Customer Service Data Collection	2, 1	Telephone Survey ,   Email Survey
WiTS Climate Survey 2015	1	2015 WiTS Climate Survey
Office of Human Resources (OHR) Training Survey	1	HR Training Survey
NLM NCBI GRC Website User Survey	1	NLM NCBI GRC Website User Survey Instrument
ODP Pathways to Prevention Survey -For Profits	1	Survey Screenshot
NLM MedlinePlus Connect Customer Survey	1	Survey
Customer Feedback on NIH's Targeted Guidance for New Investigators	1	Survey Screenshot
Future Research Leaders Conference Survey	1, 2	FRLC pre-conference survey screenshot ,   FRLC Post-Conference Survey Screenshot
NIH Office of Intramural Training & Education (OITE) – Graduate & Professional School Fair Feedback	1	Graduate and Professional School Fair Feedback Collection
NLM Traveling Exhibition Visitor Study	1	NLM Traveling Exhibition Visitor Survey
Health Information Technology Patient Satisfaction Survey (CC)	1	Patient Portal Online Survey Screenshot
LRP Qualitative Research	1	LRP Qualitative Research
NLM NCBI CCDS User Survey	1	NLM NCBI CDDS Survey Instrument
Analytical Methods and Reference Materials Program Stakeholder Interviews (Not for Profit)	1	ODS Interview Guide for AMRA Stakeholders
Future Research Leaders Conference –Communication Survey	1	FRLC Communication Survey Screenshots
2017 GSRP Website Survey Applicant	1	2017 GSRP Website Survey
NLM MedlinePlus Page Google Survey Satisfaction Rating	1	NLM MedlinePlus Google Survey Instrument (screenshots)
National Institute of Mental Health (NIMH) Office of the Director and Extramural Programs Workforce Resource Analysis	1, 1	EX Workforace Analysis Focus Group Discussion Guide ,   EX Workforace Analysis Discussion Guide
Medical Arts Branch (MAB) Services Survey	1	Medical Arts Branch Survey
Pathways for Teamwork Customer Satisfaction Interviews	1	Needs Analysis Interview Protocol
NCBI 2017 Website User Survey	1	NCBI 2017 Website User Survey Instrument
NLM Main Website Satisfaction Survey	1	NLM Main Website Satisfaction Survey Instrument
Change Readiness Survey	1	Change Readiness Survey
NIH Events Management – Post Production Survey	1	FY17 EM Post Production Survey
NIH Events Management – Audio Visual Survey	1	FY 17 EM Audio Visual Survey
The NIH Extramural Loan Repayment Programs: Online Customer Service Survey About the Application Technical Assistance Webinar	1	FY2018 LRP Webinar Survey
NLM Survey for MedlinePlus Page Satisfaction	1	NLM MedlinePlus Survey Instrument
ODP Pathways to Prevention Survey II	1	Obesity Methods P2P Survey
Basic electronic survey to inform development of a nursing research brochure (NINR)	1, 1	NINR Survey instrument ,   NINR Survey screenshots
NEI Health Focus Groups with New Audiences Ages 25-35	1, 2	NEI Screener ,   NEI Mod Guide
Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (State, Local or Tribal)	1	PEP Aware-Act-Use survey
NIMH Website Survey	1	NIMH Website Survey
Career Symposium Feedback	1	CAREER SYMPOSIUM FEEDBACK
NIH Research Training Institutes (RTIs) Customer Satisfaction Surveys	1, 2, 3	Applicants Survey ,   Faculty Survey ,   Trainee Survey
NLM NCBI Health Resources Survey	1	NLM NCBI Health Resource Survey screenshots
NLM Genetic Home Reference User Study	1	NLM GHR Use Study Interview Instrument
Participant Feedback on 2016 NIH Common Fund High-Risk, High-Reward Research Symposium	1	Survey 2016 HRHR Symposium screenshot
IntraHR Website Customer Satisfaction Survey	1	IntraHR Customer Satisfaction Survey
NLM ToxTutor User Survey	1	NLM ToxTutor User Survey Instrument
NLM GHR User Study Screening Survey	1	NLM GHR User Study Screening Survey Instrument
NLM NCBI Gene Resources Website Survey	1	NLM NCBI Gene Resources Website User Survey Instrument
Drupal Implementation and Content Enhancement (DICE) Focus Groups	1	DICE Focus Group Questions
NLM DOCLINE Customer Service Survey	1	NLM DOCLINE Customer Service Survey Instrument
NCI OSFM Conference Room Services Survey	1	Survey
Data and Safety Monitoring Meeting Evaluation	1 (Screenshots), 1	KAI Research Questions for NIAMS Customer Survey ,   KAI Research Questions for NIAMS Customer Survey
Customer Satisfaction with the Contribution of Site Visits to Assess Institutional Training Grant Applications (NIGMS)	1	Sit Visit Survey Questions
NLM NCBI Microbe Conference Survey	1	NLM NCBI Microbe Conference Survey Instrument
Chair Survey	1	Chair Fair Survey
Children's Health Exposure Assessment Resource (CHEAR) Client Satisfaction Survey	1	CHEAR Client Satisfaction Survey
NLM Website Survey for Website Satisfaction Rating	1	NLM Websites Survey
NCBI 2017 Sequence Database User Survey	1	NCBI Sequence Database User Survey
Brother, You're on My Mind (BYOMM) Knowledge Attitudes and Believes Form	1	BYOMM KAB Form
NLM AIDSource 2017 Survey	1	NLM AIDSource 2017 Survey
ORF Workplace Aesthetic Survey (OD)	1	NIH Rockledge Visual Vocabulary Survey
Benefits & Payroll Liaison Branch (BLPB) Customer Satisfaction Survey	1	Retiree Survey
NCBI Medical Genetics and Variation Web Resources 2017 Survey	1	NCBI Medical Genetics 2017 Survey Instrument
Human Resources Classification and Recruitment Documents System (HR CARDS) Survey	1	HRCARD Survey Questions
NLM NCBI 2018 Representative Genomes Survey	1	NCBI 2018 Representative Genomes survey instrument
Medicine: NIH Mind the Gap Webinar Series Survey II	1	MtG Customer Satisfaction Survey - survey Monkey Screnshot
NLM 2018 Public Libraries Association Survey	1	NLM 2018 Public Libraries urvey
Partnerships for Environmental Public Health Program (PEPH) Aware-Act-Use Survey (Individuals/households)	1	PEPH Aware-Act-Use instrument
The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Recommenders/Referees	1	LRP Referee Survey- Screenshots
Office of Human Resources (OHR) Pulse Survey	1	OHR Pulse Survey
Shuttle Bus Survey for Fishers Lane	1	OAS Shuttle Survey Screenshots
Influenza Vaccine Survey	1	2016 Flu Survey
NCI OSFM Express Services Survey	1	Express Services Survey
Workflow Information Tracking System (WiTS) Focus Groups	1	WiTS Focus Group instrument
DVR Customer Service Survey - Animal Procurement	1	Animal Procurement Survey
CTSU Website Customer Satisfaction Surveys	1, 1	1 NCA Survey ,   2 General CTSU Website Survey
CSR Poll on Grant Award Productivity using the Relative Citation Ratio (RCR)	1	CSR Questions MAG
The NIH Director's Blog Readership Survey	1	Survey
NLM TOXNET 2018 Workshop Survey	1	NLM Toxnet 2018 Workshop Survey Instrument
Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Private Sector)	1	PEPH Aware-Act-Use Survey
NIMH Professional Coalition for Research Progress Meeting Assessment Form	1	Professional Coalition for Research Progress Meeting Assessment form
Workstyle Survey	1	Qualtrics Print
The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Award Applicants	1	LRP Survey for Mentors-Screenshots 2
2015 NIH Single Cell Analysis Investigators Meeting Survey	1	2015 NIH Single Cell Analysis Investigators Meeting Survey
Traveling Exhibition Host Survey	1	Host Survey
NLM MedlinePlus Website Usability Testing	1	NLM MedlinePlus Usability Testing ICR Instrument
NIH Office of Intramural Training & Education (OITE) – Management Boot Camp Feedback	1	MANAGEMENT BOOT CAMP FEEDBACK Form
National Institute of Mental Health (NIMH) Employee Engagement Survey	1	NIMH Employee Engangement Survey
NLM Library Operations Customer Satisfaction Survey	1	NLM LO Customer Service Survey Instrument
NCI OSFM Relocation Survey- Lab	1	Lab Relocation
NLM ClinVar 2017 Website User Survey	1	NLM NCBI ClinVar 2017 Survey Instrument
DSSEM Application and Interview Satisfaction Survey	1	DSSEM Application and Interview Survey
OHR Website Customer Satisfaction Survey	1	OHR Website survey
Ombudsman Services Feedback Survey	1	NIH OOCCR Feedback Survey
NIH Events Management – Video Production Survey	1	FY17 EM Video Production Survey
NLM NCBI ClinicalTrials.gov Website Usability Survey 2017	1	NLM NCBI CT Usability Survey
NIH Library Survey: Weekend Library Use	1	Weekend Use Nov 2017 Survey
Outcomes of IDeA Core Optimization Administrative Supplements	1	NIGMS CRCB IDeA Core Supplement Follow-up Questions
NLM NCBI 2018 Literature Resources Survey	1	NCBI 2018 Literature Resources Survey
The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Mentors	1	LRP Survey for Mentors- Screenshots
Information Management Team (IMT) Web Intercept Survey	1	IMT Intercept survey Form
NLM Customer Service Satisfaction Survey	1	Survey Instrument
Qualitative Research to Explore Barriers and Facilitators for LRP Ambassadors to Promote the NIH Loan Repayment Programs	1	Key Informant Interview Guide
NIMH Information Resource Center (IRC) Customer Satisfaction Surveys for Email Information Services, Online Publications Ordering Services and Telephone Services	1, 3, 2	Email services survey ,   Online publications ordering services survey ,   Telephone services survey
Educational Game Focus Group	1, 4, 5, 2, 3	Screeners ,   Clinical Professional Consent Form and Script ,   Teacher Consent Form and Script ,   Parent Consent Form and Scriot ,   Child Assent Form
NLM Reading Rooms Satisfaction Survey	2, 1	Survey Screenshots ,   Survey (paper version)
Awardees Feedback Survey on NHLBI PAR-10-005 and PAR-13-002, NHLBI Clinical Trial Pilot Studies (R34)	1	Email Survey
NLM Project SHARE website assessment	1	Focus Group Questions
NHLBI's Health Information Center (HIC)	1, 2	Survey Instrument IVR ,   Survey Instrument Web Questions
The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Institutional Business Officials (IBOs)	1	LRP IBO Survey- Screenshots
2016 Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Principle Investigators' (PI) Meeting Post-Conference Evaluation Survey	1	2016 BRAIN PI Meeting Survey Screenshots
NCI OSFM Fitness Center Survey	1	NCI OSFM Fitness Survey
DVR Cutomer Service Survey - Animal Services	1	Animal Services Survey
Participant Feedback on 2017 NIH Common Fund 2017 Stimulating Peripheral Activity to Relieve Conditions (SPARC) Research Program Annual Awardee Meeting	1	Survey screenshot
NIH Events Management – Scheduling Services Survey	1	FY17 EM Scheduling Services Survey

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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	759,000	759,000	0	0	0	0
Annual Time Burden (Hours)	148,074	148,074	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $350,000

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: 01/29/2015

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