Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0925-0648 Expiration Date: 05/2021)
National Institute of Mental Health (NIMH) Core Facility User Survey
TYPE OF COLLECTION: (Check one)
Customer Comment Card/Complaint Form Customer Satisfaction Survey Usability Testing (e.g., Website or Software Small Discussion Group Focus Group Other:
I certify the following to be true:
The collection is voluntary.
The collection is low-burden for respondents and low-cost for the Federal Government.
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.
Information gathered will not be used for the purpose of substantially informing influential policy decisions.
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: Jennifer E. Mehren, Ph.D., Division of Intramural Research Programs, NIMH
To assist review, please provide answers to the following questions:
Is personally identifiable information (PII) collected? Yes No
If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? Yes No
If applicable, has a System or Records Notice been published? N/A Yes No
Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? Yes
Category of Respondent |
No. of Respondents |
No. of Responses per Respondent |
Time per Response (in hours) |
Total Burden Hours |
Private Sector – Researchers |
85 |
1 |
6/60 |
9 |
|
|
|
|
|
Totals |
85 |
85 |
|
9 |
Category of Respondent |
Total Burden Hours |
Hourly Wage Rate* |
Total Burden Cost |
Private Sector – Researchers |
9 |
$35.76/hour |
$321.84 |
|
|
|
|
Totals |
|
|
$321.84 |
*Cite source per bls.gov if applicable - https://www.bls.gov/oes/current/oes190000.htm.
FEDERAL COST: The estimated annual cost to the Federal government is: $2,565.31
Staff |
Grade/Step |
Salary |
% of Effort |
Fringe (if applicable) |
Total Cost to Gov’t |
Federal Oversight |
|
|
|
|
|
Scientific Advisor |
GS-14/8 |
$141,328 |
0.4% |
|
$565.31 |
Contractor Cost |
|
|
|
|
|
Management Analyst |
|
$100,000 |
2% |
|
$2,000.00 |
Travel |
|
|
|
|
|
Other Cost |
|
|
|
|
|
TOTAL |
|
|
|
|
$2,565.31 |
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
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 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?
Each core facility will provide us with their list of users from the last four years. We will send the survey to all users listed.
How will you collect the information? (Check all that apply)
X Web-based or other forms of Social Media
Telephone
In-person
Other, Explain
Will interviewers or facilitators be used? Yes
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | Generic Clearance Submission Template |
Subject | Generic Clearance Submission Template |
Author | OD/USER |
File Modified | 0000-00-00 |
File Created | 2021-05-03 |