Fast Track NINR Brochure

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: Basic electronic survey to inform development of a nursing research brochure.

PURPOSE:

This is a request for OMB to approve an online survey instrument that will be conducted on behalf of the National Institute of Nursing Research (NINR), part of the National Institutes of Health (NIH), to inform the development of a nursing research brochure. The purpose of the brochure is to increase the awareness of NINR and nursing research. The proposed instrument will gather input on a draft brochure to make sure it is clear, even to a lay audience, and appealing in design.

DESCRIPTION OF RESPONDENTS:

The data collection process will include a total of one (1) online survey consisting of ten (10) questions. The target audiences for this survey are: the general public, college and graduate school students, educators, and health care professionals. There are no eligibility criteria regarding gender, ethnicity or geographic location.

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: Adrienne Burroughs, MHS, NINR/NIH

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 [ ] No

Email addresses will be voluntarily collected, if respondents would like to receive a gift card for their participation. The survey itself does not collect any PII. NINR is waiting on guidance on whether it will be necessary to complete a TPWA (see Appendix C).

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	100	1	15/60	25
Totals	100	100		25

Category of Respondent	Total Burden Hours	Hourly Wage Rate*	Total Burden Cost
Individuals or Households	25	$21.50	$537.50
Totals	25		$537.50

*Sources:

https://www.bls.gov/ooh/about/data-for-occupations-not-covered-in-detail.htm#251199

FEDERAL COST: The estimated annual cost to the Federal government is $4,562.

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Health Communication Specialist	13/6	$113,132	1%		$1,131
Health Communication Specialist	13/6	$113,132	1%		$1,131
Contractor Cost					$2,300
Travel
Other Cost
Total					$4,562

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?

The survey will be accessible via hyperlink, which will be sent via email to stakeholders at large organizations and institutions. The stakeholders will be asked to share the survey invitation with their networks.

The survey’s first few questions will make sure there are a mix of respondents. We will accept potential participants until the maximum quota for each category (student, educator, etc.) has been reached. Please see Appendix B: Outreach Language for sample communications to disseminate the survey.

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