CSP_Survey Justification A_20150722

VA COOPERATIVE STUDIES PROGRAM (CSP)

VA Form 10-10074, CSP CUSTOMER SATISFACTION Survey

VA Form 10-10074A, Meeting Evaluation
OMB FORM 2900-0772

Expiration – XX/XX/XXXX

A. JUSTIFICATION

1. Explain the circumstances that make the collection of information necessary. Identify legal or administrative requirements that necessitate the collection of information.

“Legal authority for this data collection is found under 38 USC, Part I, Chapter 5, Section 527, “Evaluation and Data Collection,” that authorizes the collection of data that will allow measurement and evaluation of the Department of Veterans Affairs Programs, the goal of which is improved health care for veterans.”

This is a non-substantive change and only the name of the survey is changing; all other details and information remains the same.

2. Indicate how, by whom, and for what purposes the information is to be used; indicate actual use the agency has made of the information received from current collection.

The information collected will be used by VA Cooperative Studies Program (CSP) leadership to evaluate their Coordinating Centers’ effectiveness in conducting meetings and interacting with participating study sites and other customers.

VA Form 10-10074, CSP Customer Satisfaction Survey: The CSP Customer Satisfaction Survey will be used to gauge the level of customer satisfaction VA sites participating in CSP Research studies have in the CSP Coordinating Centers. The survey will ask site personnel participating on a CSP study to rate the Coordinating Centers level of proficiency, knowledge and customer service in conducting the studies. Results will be used to find areas of improvement for the Coordinating Centers, and is an important part of their effort to continue International Organization for Standardization 9001 (ISO) certification.

VA Form 10-10074A, CSP Meeting Evaluation: The CSP Meeting Evaluation will be used to gauge the effectiveness of CSP’s in-person meetings and ways to improve future meetings. The CSP Coordinating Centers regularly coordinate large meetings for CSP studies, and finding ways to run more efficient meetings can result in significant savings for the VA. The evaluation form will ask meeting attendees to rate the meetings preparation, execution and usefulness.

3. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g. permitting electronic submission of responses, and the basis for the decision for adopting this means of collection. Also describe any consideration of using information technology to reduce burden.

The data for the Meeting Evaluation is collected on paper forms. Since the surveys will normally be given to attendees of CSP study meetings and collected immediately after, improved information technology will not decrease the burden on the public.” The data for the Customer Satisfaction survey will be collected electronically using Sharepoint.

4. Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purposes described in Item 2 above.

Previous OMB surveys were focused on patient satisfaction. These surveys are intended to evaluate the service that CSP Coordinating Centers are providing the study personnel at the participating research sites.

5. If the collection of information impacts small businesses or other small entities, describe any methods used to minimize burden.

These surveys are only for participants in CSP research studies. No small businesses or other small entities are impacted by the information collection.

6. Describe the consequences to Federal program or policy activities if the collection is not conducted or is conducted less frequently as well as any technical or legal obstacles to reducing burden.

CSP Central Office has made ISO 9001 certification a priority for the Coordinating Centers. Annual review of customer satisfaction is an important element of certification, and not collecting this information could risk certification.

7. Explain any special circumstances that would cause an information collection to be conducted more often than quarterly or require respondents to prepare written responses to a collection of information in fewer than 30 days after receipt of it; submit more than an original and two copies of any document; retain records, other than health, medical, government contract, grant-in-aid, or tax records for more than three years; in connection with a statistical survey that is not designed to produce valid and reliable results that can be generalized to the universe of study and require the use of a statistical data classification that has not been reviewed and approved by OMB.

There are no such special circumstances.

8. a. If applicable, provide a copy and identify the date and page number of publication in the Federal Register of the sponsor’s notice, required by 5 CFR 1320.8(d), soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken by the sponsor in responses to these comments. Specifically address comments received on cost and hour burden.

The notice of Proposed Information Collection Activity was published in the Federal Register on January 17, 2014, at Vol. 79, page 3269. We received no comments in response to this notice.

b. Describe efforts to consult with persons outside the agency to obtain their views on the availability of data, frequency of collection, clarity of instructions and recordkeeping, disclosure or reporting format, and on the data elements to be recorded, disclosed or reported. Explain any circumstances which preclude consultation every three years with representatives of those from whom information is to be obtained.

Outside consultation is conducted with the public through the 60- and 30-day Federal Register notices.

9. Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.

No payment or gift is provided to respondents.

10. Describe any assurance of privacy, to the extent permitted by law, provided to respondents and the basis for the assurance in statute, regulation, or agency policy.

Information on these forms will become part of a system of records which complies with the Privacy Act of 1974. This system is identified as "Veteran, Patient, Employee and Volunteer Research and Development Project Records-VA (34VA12)" as set forth in the Compilation of Privacy Act Issuances via online GPO access at http://www.gpoaccess.gov/privacyact/index.html.

11. Provide additional justification for any questions of a sensitive nature (Information that, with a reasonable degree of medical certainty, is likely to have a serious adverse effect on an individual's mental or physical health if revealed to him or her), such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private; include specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.

There are no questions of a sensitive nature.

12. Estimate of the hour burden of the collection of information: 166

a. The number of respondents, frequency of responses, annual hour burden, and explanation for each form is reported as follows:

VA Forms	No. of respondents	No. of responses (X 1)	No. of minutes (X 10)	÷ by 60=	Number of Hours
VA Form 10-10074 CSP Customer Satisfaction Survey (S001)	500	1	5000		83.33
VA Form 10-10074A Meeting Evaluation (S002)	500	1	5000		83.33
	1000		ROUND TOTAL		166

b. If this request for approval covers more than one form, provide separate hour burden estimates for each form and aggregate the hour burdens in Item 13 of OMB 83-I.

This request covers only one form—OR—See chart in subparagraph 12a above.

c. Provide estimates of annual cost to respondents for the hour burdens for collections of information. The cost of contracting out or paying outside parties for information collection activities should not be included here. Instead, this cost should be included in Item 14.

VA does not require any additional recordkeeping. The cost to the respondents for completing these forms is $3,984.00 ($24 per hour x 166 burden hours).

13. Provide an estimate of the total annual cost burden to respondents or recordkeepers resulting from the collection of information. (Do not include the cost of any hour burden shown in Items 12 and 14).

a. There is no capital, start-up, operation or maintenance costs.

b. Cost estimates are not expected to vary widely. The only cost is that for the time of the respondent.

c. There is no anticipated recordkeeping burden.

14. Provide estimates of annual cost to the Federal Government. Also, provide a description of the method used to estimate cost, which should include quantification of hours, operation expenses (such as equipment, overhead, printing, and support staff), and any other expense that would not have been incurred without this collection of information. Agencies also may aggregate cost estimates from Items 12, 13, and 14 in a single table.

The estimated annual cost to the Federal Government for VA Form 10-10074 and 10-10074A
is $3,550.

Paper/Printing: $50

Administration - $1000

Participant cost - $2500

15. Explain the reason for any burden hour changes or adjustments reported in items 13 or 14 of the OMB form 83-1.

This is a revision of a previously approved collection. There is no change in burden hours. There are no longer paper/printing costs associated with the Customer Satisfaction survey so those costs were deducted. The form numbers changes from 10-0511 to 10-10074 to remediate overlapping numbers.

16. For collections of information whose results will be published, outline plans for tabulation and publication. Address any complex analytical techniques that will be used. Provide the time schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.

VA does not intend to publish this data.

17. If seeking approval to omit the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.

A valid expiration date has been included on all associated documents in this submission package.

18. Explain each exception to the certification statement identified in Item 19, “Certification for Paperwork Reduction Act Submissions,” of OMB 83-I.

There are no exceptions.

B. Statistical Methods. The data collection does not employ statistical methods.

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