Fast Track Submission Form

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0925-0655 Exp. Date: 03/31/2015)

T ITLE OF INFORMATION COLLECTION: Clinician and Adolescent Feedback for the Development of an Adolescent Substance Use Continuing Medical Education/Continuing Education (CME/CE) Program

PURPOSE:

As part of the National Institute on Drug Abuse’s (NIDA’s) mission to bring the power of science to bear on drug abuse and related health consequences (Public Law Section 464P (42 USC 285o-4)), the NIDAMED initiative (http://www.drugabuse.gov/nidamed-medical-health-professionals) develops resources about drug abuse and addiction for practicing physicians, other health care clinicians, and those in training. As part of this ongoing initiative, NIDA is now funding the development of a CME/CE program that will provide clinicians with practical skills and information to prevent, identify, and manage adolescent substance use.

To inform the development of the adolescent substance use CME/CE program, three types of surveys will be conducted: 1) a clinician survey, 2) a pharmacist survey and 3) an adolescent survey. The clinician and pharmacist surveys will be used only to identify stakeholder preferences for the content and format of the CME training to ensure it meets their educational needs. The adolescent survey will identify which communication practices will resonate successfully with adolescent patients (e.g., if it is better to provide adolescents with a handout with information or direct them to a website). Without this feedback we have no other way to accurately gauge the needs and expectations of our customers to effectively tailor the training materials. 

All survey information collected will only be used internally at NIDA to guide discussions with a technical expert panel that is developing content for the CME/CE program. Only aggregate conclusions and impressions of stakeholder preferences will be shared with the expert panel. No individual level responses will be shared nor will information be used outside of HHS.

DESCRIPTION OF RESPONDENTS:

Clinician Survey: The respondents to this survey will be primary care clinicians (i.e., physicians, nurse practitioners, pediatricians, physician assistants, and oral/maxillofacial surgeons).

Pharmacist Survey: The respondents to this survey will be pharmacists. Please note: the pharmacist survey differs from the clinician survey in only a few questions/response options.

Adolescent Survey: The respondents to the adolescent survey will be adolescents ages 13 to 19.

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: Online Survey

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:____ Elisabeth Davis, NIDA, NIH _____________________________

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 [X] 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? [X] Yes [ ] No

Adolescent Survey: Based on our previous experience, modest incentives are necessary to encourage participation of adolescents. Adolescents selected for this survey are members of a commercially available, online survey panel comprised of teenagers across the country who have opted in—with parental approval—to participate in internet surveys. Adolescents will receive points for completing the survey. Points are valued at about $3.00. Accumulated points can be redeemed toward a voucher for a gift—for example, a magazine subscription, movie tickets, restaurant coupons, or similar items.

Clinician and Pharmacist Surveys: Clinicians/pharmacists will not receive any incentive to participate.

ESTIMATED BURDEN HOURS and COSTS

Please Note: The tables below specify the clinician type (e.g., physician, nurse practitioner, etc.) in addition to listing “individual/household”—in the category of respondent column. The type of individual clinician is reported separately because of the variance in wage rate as provided by the Bureau of Labor Statistics. Additionally, adolescents are separated between those of working age (16-19) and those not of working age (13-15) to allow for minimum wage rate to be applied only to those considered working age. We estimate that of our total adolescent population (400 respondents), 100 will be ages 16-19.

Category of Respondent	No. of Respondents	No. of Responses per Respondent	Time per Response (in hours)a	Total Burden Hours
Individual/ household (Nurse Practitioners, Physician Assistants)	3,117	1	7/60	365
Individual/household (Physicians)	914	1	7/60	107
Individual/household (Oral/maxillofacial surgeons)	379	1	7/60	44
Individual/household (Pharmacists)	665	1	7/60	78
Individual/ household (Adolescent of Non-working adolescents ages 13-15)	300	1	5/60	25
Individual/ household (Adolescent group of Working adolescents ages 16-19	100	1	5/60	8
Totals	5,475			627

Category of Respondent	Total Burden Hours	Wage Rate	Total Burden Cost
Individual/ household (Nurse Practitioners, Physician Assistants)	365	$45.54b	$16,622.10
Individual/household (Physicians)	107	$87.00c	$9,309.00
Individual/household (Oral/maxillofacial surgeons)	44	$105.27d	$4,631.88
Individual/household (Pharmacists)	78	$56.01d	$4,368.78
Individual/ household (Adolescents ages 13-15; non-working)	25e	$0.00	$0.00
Individual/ household (Adolescents ages 16-19; working)	8e	$7.25f	$58.00
Totals	627		$34,989.76

FEDERAL COST: The estimated annual cost to the Federal government is $1,946

Staff	Grade/Step	Salary	% of Effort	Fringe (if applicable)	Total Cost to Gov’t
Federal Oversight	GSA 13/Step 6	$105,960	0.20%		$212
Contractor Cost		$164,747	0.1%	60	$225
		$51,410	1.1%	208	$774
		$41,763	0.2%	31	$115
Travel					$0
Other Cost					$620
Total					$1,946

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?

Customer List:

Clinician and Pharmacist Surveys: NIDA is collaborating with eight medical professional organizations that represent the primary care clinicians that are the target audience for the CME/CE and the clinician and pharmacist surveys. These eight medical professional organizations will distribute a link to the survey to a random sample of their members. NIDA will not receive the email addresses or contact information of the respondents.

Adolescent survey: adolescents (ages 13-19), will be recruited from a commercially available, online survey panel comprised of teenagers across the country who have opted in—with parental approval—to participate in internet surveys.

The commercially available panels are designed to target specific types of individuals (including teenagers) in the United States. Previous experience conducting quantitative research projects with teenagers indicates that sample panels are the most efficient way to recruit significant numbers of teenagers from across the country. The invitation to participate in the survey will be sent by email from the Internet panel. NIDA will not receive the email addresses or contact information of the respondents.

This sampling approach, described below, is appropriate for analysis purposes, enabling us to get a broad representation of NIDA target audience/customer and offering the ability to quickly recruit with minimal impact.

Sampling Plan:

Clinician and Pharmacist Surveys: The membership of the eight medical professional organizations is the universe respondents. A random sample of the eight medical professional organization’s members will receive the clinician survey.

Adolescent Survey: To reach adolescents, the sample will be randomly drawn from the adolescent opt-in survey pool/database, according to the project needs and consistent with sampling techniques according to the age and gender quotas set in the survey instrument and the anticipated response rate per quota group. 

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

a To calculate Time per Response, calculation was taken to 3 decimals and the following calculations were used: 7/60 = 0.117 and 5/60 = 0.083

b Hourly wage calculated by averaging the reported mean hourly wage of Nurse Practitioners ($45.71) and Physician Assistants ($45.36). (http://www.bls.gov/oes/current/oes_nat.htm#29-0000)

c Hourly wage calculated averaging the reported mean hourly wage of Family/GPs ($88.43); Internists, General ($90.60); and Pediatricians ($81.98). (http://www.bls.gov/oes/current/oes_nat.htm#29-0000)

d Hourly wage derived from the mean hourly wages reported Pharmacists. http://www.bls.gov/oes/current/oes_nat.htm#29-0000

eTo calculate the total burden cost for adolescents, it is estimated that 25% of the 400 total adolescent respondents are working.

f Current reported minimum wage—according to: http://www.dol.gov/whd/minimumwage.htm

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