fast track EAP COVID Survey

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0925-0648; Exp. Date: 05/31/2021)

TITLE OF INFORMATION COLLECTION: Survey Soliciting Employee Assistance Program (EAP) Customer Satisfaction

PURPOSE: The Employee Assistance Program (EAP) seeks to gather brief customer feedback about counseling services received during COVID-19.

DESCRIPTION OF RESPONDENTS: The respondents for the survey are NIH consumers who utilized EAP counseling services from 04/1/2020-11/30/2020.

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.

Signature: Anna Verschoore

Name:_________Anna Verschoore_______________________________________

NIH Federal Coordinator, Employee Assistance Program

OD, ORS, DOHS, OMS

Room B2B57, Building 31

301 496 3164

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? N/A [ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [XX ] 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
Individual/households	400	1	5/60	33
Totals		400		33

Category of Respondent	Total Burden Hours	Hourly Wage Rate*	Total Burden Cost
Individual Federal Government Employees and Contractors	33	$28	$924
Totals			$924

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

FEDERAL COST: The estimated annual cost to the Federal government is $1335.00

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight
Chief	13/10	$133,465	.010	N/A	$1335
Contractor Cost	N/A	N/A	N/A	N/A	N/A
Travel	N/A	N/A	N/A	N/A	N/A
Other Cost	N/A	N/A	N/A	N/A	N/A
Total					$1335

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?

From the EAP internal data base, we have collected names and email addresses for all Federal Employee and Contractor consumers who were seen for counseling services from 4/1/2020-11/30/2020, who provided permission for a follow up survey and contact via email. This group of consumers will be sent an email explaining the brief survey with a link to provide their anonymous response to 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