DVBIC Climate Assessment one-pager

Request for Approval under the “Fast Track Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0704-0553);

T ITLE OF INFORMATION COLLECTION: Defense and Veterans Brain and Injury Center (DVBIC) Climate Assessment

PURPOSE: The Defense and Veterans Brain Injury Center (DVBIC) is experiencing a significant workforce departure rate. It is expected by the end of March that approximately 29% of its workforce will have departed DVBIC since September 2018. There are some known factors for this loss of staff; however, there are also a large percentage (12%) of the staff who have departed without a known reason. DVBIC needs to conduct a brief survey in order to understand the impact that the loss of staff has had on the climate of its workforce, as well as explore those unknown factors that contributed to the loss of staff. Approximately 95% of DVBIC’s workforce consist of contractors. This survey is strictly voluntary, anonymous, and is designed to only require a very brief amount of time to answer. DVBIC plans to use MaxSurvey as the survey platform as it is approved by the Defense Health Agency.

DESCRIPTION OF RESPONDENTS: Designated contractors.

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: Climate Assessment

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: James A. Blankenship, CAPT USPHS

Chief, Mission Support Office

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 [ ] 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 hours
Individuals and households	194	5 mins	16.16
Totals	194	5 mins	16.16

FEDERAL COST: Based on an hourly average of $69.94 by 194 employees, the estimated cost to the Federal government is: $1,130.23. The hourly average wage was found by examining the three existing DVBIC contracts and averaging all of the salaries.

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?

All DVBIC employees are being offered the survey.

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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