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

TITLE OF INFORMATION COLLECTION: Joint Patient Safety Reporting (JPSR) Training Office Hours Survey

PURPOSE:

DHA Joint Patient Safety Reporting (JPSR) team is offering a new “Office Hours” series focusing on training Defense Health Agency (DHA) and Veterans Health Agency (VHA) users in the operation of the JPSR application. The series is a monthly series addressing DHA/VHA user training and education needs using Microsoft Teams Meeting as the delivery mechanism. JPSR will establish a survey to capture training feedback in order to evaluate the training. The collection is intended to collect feedback from trainees about the Office Hour session to enable the JPSR Project Office to measure trainees' satisfaction with the training and gather valuable insights for improving future sessions, identify if the training provides is meeting our intended outcomes, as well as assist in determining topics for future sessions.

DESCRIPTION OF RESPONDENTS:

The respondents will consist of Defense Health Agency (DHA) and Veterans Health Agency (VHA) users of the Joint Patient Safety Reporting System. Respondents will consist of Active-Duty Military, Government Civil Service, and Contractor personnel who use JPSR in performance of their duties in the execution of the DHA and VHA Patient Safety Programs.

TYPE OF COLLECTION: (Check one)

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

[ ] Usability Testing (e.g., Website or Software [ ] 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: Donna J. Kays, Product Manager, Solution Delivery Division, Clinical Support PMO

Joint Patient Safety Reporting (JPSR)

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 [X] 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	200	5 minutes	17 hours
Totals

PUBLIC COST: The estimated annual cost to the public is $475.33. This is based off GS-11 hourly pay.

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?

The DHA Joint Patient Safety Reporting (JPSR) “Office Hours” series focuses on training Defense Health Agency (DHA) and Veterans Health Agency (VHA) users in the operation of the JPSR application using the Microsoft Teams meeting as delivery platform. DHA/VHA users are invited to participate in the training. Training Participants (aka Respondents) log into Microsoft Teams to attend the training session. JPSR Program Office will utilize the training participants listing as the potential listing of respondents when offering a feedback / evaluation survey. Completing the survey will not be mandatory nor a prerequisite to attend/receive training.

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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