Fast track template NIMH Website Survey

Request for Approval under the “Generic Clearance for the Collection of
Routine Customer Feedback” (OMB#: 0925-0648 Expiration Date: 03/2018)
TITLE OF INFORMATION COLLECTION:
NIMH Website Survey
PURPOSE:
NIMH will conduct an online customer satisfaction survey to engage our website users twice per
year. The survey will provide useful information about how to best serve our website users,
enhance our understanding of their needs and facilitate obtaining instant feedback which will
allow NIMH to make decisions and improvements to our website quickly and more effectively.
Each administration of the survey will collect up to 5,000 responses. The survey will run on the
NIMH website and data will be integrated with our Google Analytics reports.
DESCRIPTION OF RESPONDENTS:
The respondents are NIMH website users. Website users may include, but are not limited to,
advocacy groups, researchers, practitioners, mental health professionals, patients, family
members/friends, health care providers and the general public.

TYPE OF COLLECTION: (Check one)
[ ] Customer Comment Card/Complaint Form
[ ] Usability Testing (e.g., Website or Software
[ ] Focus Group

[X] Customer Satisfaction Survey
[ ] Small Discussion 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: Karen Carter-McLeod, Technical Information Specialist, ECB/NIMH
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:

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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

Individuals or Households

10,000

No. of
Responses
per
Respondent
1

Totals

10,000

1

Time per
Response
(in hours)

Total Burden
Hours

15/60

2500

15/60

2500 hours

Category of Respondent

Total Burden
Hours

Hourly Wage Rate*

Total Burden
Cost

Individuals or Households

2500

$22.71

$56,775

Totals

2500

$22.71

$56,775

*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 $8,998.20

Staff
Federal Oversight
Technical Information
Specialist

Contractor Cost
Project Manager
Travel
Other Cost

Grade/Step

Salary

% of
Effort

Fringe (if
Total Cost to
applicable) Gov’t

GS-13/4

$99,964

5%

$4,998.20

N/A

$25,000

16%

$4,000.00

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

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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 strategically placed on particular pages of the NIMH site, and website
users will be prompted to complete the survey once they visit those pages of the website.
The survey will run on the NIMH site and data will be collected and integrated with Google
Analytics. The survey tool used will be iPerceptions, and each survey will collect a
maximum of 5,000 responses. The survey can be triggered to run on particular pages of the
NIMH site, and will be posted twice per year.

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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