Chair Survey

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

T ITLE OF INFORMATION COLLECTION: Chair Survey

PURPOSE:

We are collecting information for the consolidation of several NIH Institutes/Center (ICs) to two different locations – Rockledge I and II and 6700B Rockledge Drive. We are sending the survey to the Institutes and Centers directly impacted by the move.

We are asking federal employees and contractors working in the space and who will be impacted by the move to participate in web-based surveys in an effort to help drive design decisions and evaluate change readiness for the move. This will help us understand the level of change and training required leading up to the move.

The survey asks about various workstation chair preferences and options.

DESCRIPTION OF RESPONDENTS:

The respondents are the NIH federal employees and their contractors who will be consolidating their office space into the two project locations noted above.

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: Feedback ___________________

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: Brad Moss

Communication Director

Office of Research Services/Office of Research Facilities

National Institutes of Health

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 [ 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

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 (Federal Government Contractors)	300	1	2/60	10
Totals		300		10

Category of Respondent	Total Burden Hours	Hourly Wage Rate*	Total Burden Cost
Individuals (Federal Government Contractors)	10	$30	$300
Totals	10	$30	$300

*Cite source per bls.gov if applicable

http://www.bls.gov/oes/current/naics4_622300.htm#00-0000

FEDERAL COST: The estimated annual cost to the Federal government is $1628.15

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Communication Director	GS14/10	145629	0.005		728.15
Contractor Cost					900
Travel					n/a
Other Cost					n/a
Total					1628.15

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 list of respondents include the staff for each of the NIH IC’s that are part of the two consolidation projects. The number of staff for the Rockledge 1 and II consolidation is approximately 3,000. The number of staff for the 6700B is approximately 500.

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

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

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