Fast Track Template

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0925-0655)

TITLE OF INFORMATION COLLECTION: Customer Feedback Information for National Institute on Drug Abuse PEERx Videos

PURPOSE:

The purpose of this study is to collect customer feedback information that will assist the National Institute on Drug Abuse to revise and improve the PEERx Videos, the videos present scenarios of harmful effects when a young person misuses prescription drugs.

The survey results will provide actionable information for the NIDA PEERx Program team to enhance the PEERx Choose Your Path video campaigns. The information from high school youth, - the target audience of these videos-, will help NIDA improve the relevancy and increase the reach of messaging within the videos. There may be insights for use of language, types of actors, and situation-specific scenarios generated from the information that would increase their appeal to this target audience. The information from the student focus groups is expected to bring out the affective and value-laden aspects of students of diverse backgrounds, their personal and social contexts, which will help broaden the realism of the videos and reach diverse populations effectively.

DESCRIPTION OF RESPONDENTS:

The respondents will be teenagers currently attending ninth (9th) through twelfth (12th) grades at schools that participated in the 2013 and 2014 Chat Day Program, and their teachers, and counselors who may work with educating students about the harms from prescription drugs misuse.

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 [X] Other: Web Survey, Focus Groups

CERTIFICATION:

I certify the following to be true: (whatever specifics you need to include)

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 youth who will have seen the videos, and who may know about the problem of prescription drugs misuse.

Name and IC: Genevieve R. deAlmeida, National Institute on Drug Abuse, National Institutes of Health

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? [x ] Yes [] No SORN 09-25-0200 has been published on 09/26/2002, in Federal Register Volume 67, #187, page 60741-60794

For the Web Surveys: Parents will sign consent forms for their students to participate in the study. Students with parents’ signed consent will sign assent forms. Teachers will sign consent forms. Signed forms will be stored in the secure facilities of the Contractor, NIDA will not have access to these.

For the in-person Focus Groups: School Principals (of schools that participated in the survey and that are selected for this activity, on the criteria presented below) will be asked to assist with available school rooms for the focus groups. Parent of Students who indicated an interest in focus group participation will be contacted by the NIDA Contractor. Parental consent for participation will be requested and recorded, permission will be requested for a brief inclusion screening of the student. If inclusion criteria are met student assent will be recorded.

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [x] Yes [] No

An incentive of $20-$30 in educational gifts for the school will be offered to schools that are selected for the focus group and will be able to make a school room available for conduct of the focus group. A healthy snack will be offered to focus group participants if the focus group sessions are held during the school lunch period or at the end of classes for the day.

No monetary incentives will be paid to survey or focus group participants.

BURDEN HOURS

Category(s) of Respondent	No. of Respondents	Participation Time (in hrs.)	Total Burden Hrs.
Households- School Students- Survey	400	15 /60	100
Households- Teachers - Survey	50	18 /60	15
Households - School Students - Focus Group	168	90 /60	252
Households –School Students- Focus Group Screening	180	8/60	24

FEDERAL COST: The estimated annual cost to the Federal government is: $148,830, plus $950.0 or 1 percent of time of NIDA Project Officer, equaling $149,780.

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- See Attachment 1 – Sampling Plan

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[X] Web-based or other forms of Social Media

[X] Telephone

[X] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [X] Yes [ ] No

List of Attachments

Attachment 1 - Sampling Plan

Attachment 2 – Letter to Principals Explaining Study

Attachment 3 - Principal’s Consent Form

Attachment 4 - Request to Principals to Host Focus Group

Attachment 5 – Consent Assent Focus Group Participation

Attachment 6 – Consent Assent Survey

Attachment 7 - Teacher Consent

Attachment 8 – Student Survey

Attachment 9 – Teacher Survey

Attachment 10 – Screenshot Student Survey

Attachment 11 – Screenshot Teacher Survey

Attachment 12 – Messaging Moderator’s Guide

Attachment 13 – FG Moderator’s Guide

Attachment 14 – Student Focus Group Recruitment Screener

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