Fast Track Template

Request for Approval under the “Generic Clearance for the Collection of
Routine Customer Feedback” (OMB#: 0925-0648 Exp., date: 09/2025)
TITLE OF INFORMATION COLLECTION: Annual Lab Survey
PURPOSE: The purpose of this survey is to solicit feedback annually until September 2025
about the performance of the Laboratory/Branch Chiefs. We have ensured that these survey
activities, which are designed to gather and measure Laboratory/Branch members’ perceptions of
the quality of the Chief’s performance as it relates to laboratory management, administrative
management, and ethical leadership, satisfy the requirements and the spirit of Executive Order
(EO) 12862. Furthermore, periodic surveys of lab staff are part of the Board of Scientific
Counselors (BSC) leadership reviews of Laboratory/Branch Chiefs. The feedback will be
provided to the NIA BSC members for evaluation of the Laboratory/Branch Chief. Each
respondent will answer questions about their respective labs.
DESCRIPTION OF RESPONDENTS: NIA IRP full time equivalent (FTE) federal employees
and non-FTEs including contractors, trainees/fellows, guest researchers, and special volunteers.
TYPE OF COLLECTION: (Check one)
[ ] Customer Comment Card/Complaint Form
[ ] Usability Testing (e.g., Website or Software
[ ] Focus Group

[ ] Customer Satisfaction Survey
[ ] Small Discussion Group
[X ] Other: Performance Feedback

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 wh o have
experience with the program or may have experience with the program in the future.
Name: Angela Prazak, Program Specialist, OSD, NIA
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 [x ] No
Gifts or Payments:
Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to
participants? [ ] Yes [x ] No

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ESTIMATED BURDEN HOURS and COSTS
Category of Respondent

No. of Respondents

No. of Responses per
Respondent

Federal Government –
IRP FTE’s
NIA IRP-Non-FTE’s
Totals

255

1

387

Category of Respondent Total Burden
Hours
Federal Government –
42.5
IRP FTE’s
NIA IRP-Non-FTE’s
64.5
Totals
107

Time per
Response
(in hours)
10/60

Total
Burden
Hours
42.5

1
642

10/60

64.5
107

Hourly Wage Rate*

Total Burden
Cost
$935.00

$22.00
$22.00

$1,419.00
$2,354.00

*Cite source per bls.gov if applicable

FEDERAL COST: The estimated annual cost to the Federal government is $1,503.84 (onetime cost). This is estimated based on a portion of the existing subscription to Survey Monkey,
staff hours involved in preparing the survey, and email communication used for solicitation.

Staff
Federal Oversight
Program Specialist

Grade/Step

Salary*

% of
Effort

13/4

$117,505

1

Fringe (if
Total Cost to
applicable) Gov’t

$1,175.05

Contractor Cost
Title
Travel
Other Cost
$1,175.05
Total
* the Salary in table above is cited from https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salarytables/pdf/2018/DCB.pdf

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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? Each laboratory has an email distribution list, which
includes all staff in that respective area.

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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