Form 1 NIMH Core User Survey template

OMB Control Number: 0925-0648 Expiration Date: 5/31/2021

National Institute of Mental Health (NIMH) Core Facility User Survey

Public reporting burden for this collection of information is estimated to average 6 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate, or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, Maryland 20892-7974, ATTN: PRA (0925-0648). Do not return the completed form to this address.

[Survey Monkey URL]

1. Your information

   1. Name

   2. Institute (NIH Institute pull-down, and if “non-NIH”—enter name of University, company, etc.)

   3. Position Type

      1. Principal Investigator

      2. Scientific Support Staff

      3. Clinical Staff

      4. Staff Scientist/Staff Clinician

      5. Fellow (Postdoc, Clinical, Predoc, Postbac)

      6. Other (if checked, enter position type)

2. Have you used the [Enter name of Core Facility] in the past 4 years? Yes or No

3. How often did you use the core services on average? Every day or most days, once or twice a week, once or twice a month, a few times a year, one or a few times in the last 4 years

4. Please rate the [Enter name of Core Facility] [outstanding, very good, good, fair, poor (+optional comment section)]:

   1. Technological quality of the core’s services (e.g., up-to-date equipment and techniques, appropriate application of methods and technology)

   2. Customer service of the core’s staff (e.g., promptness, responsiveness to questions)

   3. Overall quality of the core service

5. Have the core services been essential to your research? Yes, No, Other (+optional comment section)

6. Do you have regular discussions with the core director and/or staff regarding acknowledgement and authorship for work performed in the core that results in publication? Yes, No, Other (+optional comment section)

7. If the service contributed to any publications, please cite them here (you may enter the title of the manuscript if you don’t have the full citation): (optional comment section)

8. Overall, how satisfied or dissatisfied are you with the [Enter name of Core Facility]’s service?

   1. Very satisfied

   2. Somewhat satisfied

   3. Neutral

   4. Somewhat dissatisfied

   5. Very dissatisfied

9. How likely is it that you would recommend this core service to colleague?

   1. Very likely

   2. Somewhat likely

   3. Neutral

   4. Not so likely

   5. Not at all likely

10. Do you have suggestions for improvement of the core’s services? (comment section)