Fast Track Submission Form

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0925-0648 Exp. Date: 03/31/2018)

TITLE OF INFORMATION COLLECTION: NLM Reading Rooms Satisfaction Survey

PURPOSE:

The goal of this survey is to help measure the customer satisfaction with the services provided in the Reading Rooms at the National Library of Medicine. The survey results will be used to better assess these services routinely provided to individuals who come into the NLM Reading Rooms to study, use the collection, use the equipment, and/or consult with staff for technical or professional services

DESCRIPTION OF RESPONDENTS:

Respondents are patrons who use the service and materials in the NLM Main Reading Room and the History of Medicine Reading Room.

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: Terry Ahmed________________________________________________

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

ESTIMATED BURDEN HOURS and COSTS

Category of Respondent	No. of Respondents	No. of Responses per Respondent	Time per Response (in hours)	Total Burden Hours
Individuals or Households	269	1	5/60	22
Totals	269	269		22

Category of Respondent	Total Burden Hours	Wage Rate*	Total Burden Cost
Individuals or Households	22	$22.71	$499.62
Totals			$499.62

*Cite source per bls.gov if applicable

BLS National Occupational Employment and Wage Estimates

http://www.bls.gov/oes/current/oes_nat.htm#00-0000

FEDERAL COST: The estimated annual cost to the Federal government is $291.92

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Librarian	GS-14/5	$121,635	0.24		$291.92
Contractor Cost					N/A
Travel
Other Cost
Total					$291.92

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 survey participants will consist of people who come into the NLM Reading Rooms to study, use the collection, use the equipment and/or consult with staff for technical or professional services.

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

[X] In-person (a paper form given to the patron)
[ ] Mail

[ ] Other, Explain

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

Attachments:

NLM Reading Room Survey (online version screen shots)

NLM Reading Room Survey Instrument (paper copy)

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