NIST Quality Assurance Program (Request Form 1)

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number 0690-0030)

TITLE OF INFORMATION COLLECTION: National Institute of Standards and Technology (NIST) Quality Assurance Program (QAP) for Metabolomics (qMet)

PURPOSE:

A collection instrument via the qMet program website was developed to determine what particular techniques, measurement challenges faced by the metabolomics measurement community, in order to for NIST to design our QAPs and reference material and data measurement services to suit the community’s quality control and quality assurance measurement needs.

DESCRIPTION OF RESPONDENTS: Members of the Metabolomics scientific community. This would include academic researchers, clinical research institutes and laboratories, hospital and diagnostic testing laboratories for clinical medicine, and diagnostic testing industries (commercial).

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ x] Small Discussion Group

[] Focus Group [ ] Other: ______________________

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:____Katrice A. Lippa Phone Number: 301-975-3116___________

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, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [x ] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No

Gifts or Payments:

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

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Individuals - Metabolomics scientific community; Part 1: QA for Metabolomics questionnaire	50	10 min	50 min
Individuals - Metabolomics scientific community; Part 2: Expression of Interest in a Urine-based Interlaboratory Comparison	50	10 min	50 min

FEDERAL COST: The estimated annual cost to the Federal government is $500________

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? [ ] Yes [x ] 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?

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 submit all instruments, instructions, correspondences (emails, letters, etc.) to respondents, and scripts as separate documents along with this request document.

Every instrument must have the following displayed –

OMB Control No. 0690-0030

Expiration Date: 06/30/2017

Required Additional Information (check ROCIS in IC List for this info ---needed for OCIO staff to complete request)

1. Line of Business: General Science and Innovation.

2. Subfunction: Scientific and Technological Research and Innovation.

3. Privacy Act System of Records: Title: Not applicable.

4. Federal Registration citation information: Volume 79 Pg. No. 9159.

5. Number of respondents for small entities: 0.

6. Percentage of respondents reporting electronically: 100%.

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