Workplace and Organizational Performance Survey

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

TITLE OF INFORMATION COLLECTION:

Workplace + Organizational Performance Survey
PURPOSE:
We are sending a survey to the National Institutes of Health (NIH) Institutes and Centers (ICs) who
work in the affected space to participate in a web-based survey to help us understand how well the
current individual spaces and collective spaces support the organizational performance of the ICs. We
are asking both federal and contract employees who will be impacted by the move to confirm their
requirements are achieved during the design and construction portions of the project. The information
collected will assist with the development of a Program of Requirements (POR) to support the lease
acquisition of replacement space for the expiring leases of 6001 Executive Boulevard and 6101
Executive Boulevard.
DESCRIPTION OF RESPONDENTS:
NIH Federal and contract employees who work in the affected spaces of 6001 Executive Boulevard
and 6101 Executive Boulevard.
TYPE OF COLLECTION: (Check one)
[ ] Customer Comment Card/Complaint Form
[ ] Usability Testing (e.g., Website or Software)
[ ] Focus Group

[ ] Customer Satisfaction Survey
[ ] Small Discussion 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.
The results are not intended to be disseminated to the public.
4. Information gathered will not be used for the purpose of substantially informing influential policy
decisions.
5. 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
Communications Director
Office of Research Services/Office of Research Facilities
National Institutes of Health

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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
Individuals
(Federal Contractors)

Total

Category of Respondent
Individuals
(Federal Contractors)

No. of
No. of
Respondents Responses per
Respondent
708
1

Time per
Response
(in hours)
15/60

Total Burden
Hours
177

708
Total Burden
Hours
177

177

Hourly Wage Rate*

Total

$27.12

Total Burden
Cost
$4,800.24

$27.12

$4,800.24

*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 $10,683.65.
Staff
Federal Oversight
Communications Director
Contractor Cost
Workplace Strategy Task Leader
(Contractor)
Project Assistant (Contractor)
Total Contractor Cost
Travel
Other Cost
Total

Grade/Step

Salary

% of
Effort

GS14/10
-

$145,629
-

0.005
-

-

$728.15
-

-

-

-

-

-

-

-

-

-

N/A
N/A

$0
$0

0
0

-

$9,955.50
N/A
N/A
$10,683.65

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Fringe (if Total Cost
applicable) to Gov’t

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 NIH Federal and contract employees who work in the affected spaces
of 6001 Executive Boulevard and 6101 Executive Boulevard. The total number of people impacted
is approximately 708.
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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