Fast Track Submission Form

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

T ITLE OF INFORMATION COLLECTION:

The NIH Director’s Blog Readership Survey

PURPOSE:

Each week, the NIH Director’s Blog highlights interesting, NIH-supported research advances for a broad readership. The blog will conduct its first online customer satisfaction survey. The results will provide useful information about how best to serve our readership, bolster our understanding of its needs and preferences, and allow us to fine-tune our communication strategies. The survey will run on the NIH Director’s Blog until a total of 1,000 responses are collected, and data will be integrated into our Google Analytics report.

DESCRIPTION OF RESPONDENTS:

The respondents are readers of the NIH Director’s Blog. The readership may include, but is not limited to, those with health concerns, researchers, students, teachers, health care professionals, and members of the general public interested in science.

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: Robert J. Kuska, Writer/Editor, OCPL, OD

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, 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	1,000	1	10/60	167
Totals	1,000	1,000		167 hours

Category of Respondent	Total Burden Hours	Hourly Wage Rate*	Total Burden Cost
Individuals or Households	167	$22.71	$3,792.57
Totals	167		$3,792.57

*United States Department of Labor, Bureau of Labor Statistics (May 2014) National Occupational Employment and Wages by Major Occupational Group (All Occupations) – see http://www.bls.gov/oes/current/oes_nat.htm#00-0000

FEDERAL COST: The estimated annual cost to the Federal government is $5,903

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Writer/Editor	GS-13/10	$118,069	5%		$5,903
Contractor Cost
Travel
Other Cost

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

3