REQUEST FOR APPROVAL TO SURVEY
DEPARTMENT OF THE ARMY PERSONNEL
THE ARMY PERSONNEL SURVEY PROGRAM
(AR 600-46)
TO:
U.S. Army Research Institute
ATTN: DAPE-ARI-PS
2511 Jefferson Davis Highway
Arlington, VA 22202-3926
DSN: 332-7858
Commercial: (703) 602-7858
E-mail: ARI_APSO@conus.army.mil
Date Submitted: ________
Date Approved/Disapproved: ________
RECOMMENDED TITLE OF SURVEY:
NAME OF MILITARY SPONSORING ORGANIZATION OR OFFICE:
POINT OF CONTACT:
MAILING ADDRESS:
TELEPHONE: Commercial:
DSN:
EMAIL ADDRESS:
PROPOSED SCHEDULE:
Survey Instrument Completion Date:
Survey Administration Dates:
Data Analysis Dates:
Final Report Date:
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HUMAN USE COMMITTEE REVIEW:
_____ Not yet requested
_____ Requested but not yet received from _________________________________________
_____ Requested and received from ________________________________________ Indicate
status below:
_____ Exempt
_____ Not exempt but approved
_____ Neither exempt nor approved
JUSTIFICATION FOR SURVEY REQUEST:
O Describe the general purpose of the survey.
O List the specific objectives being addressed by the survey.
O Describe how the survey results will be used.
BACKGROUND RESEARCH:
O Describe the planning and coordination of the survey, with a focus on what Army
organizations/offices have been contacted concerning related research.
O Describe the most recent relevant research, if any. Identify any publications, articles,
and/or papers reviewed. Include both military and civilian sources.
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TARGET POPULATION:
O Describe the population on which the survey will focus.
O Provide the estimated size of the target population.
SAMPLE:
O Describe the rationale and procedures for selecting the survey sample (provide
justification for sampling within subgroups, if proposed.)
O Provide the suggested size of the final obtained sample subgroups and total and the
desired sampling error. (Indicate over-sampling for anticipated non-response.)
ADMINISTRATION:
O Describe method of data collection, command effort required (to include administration
time), and time required for a respondent to complete survey.
O If a Web survey will be used, identify the Web site:____________________________
Is this Web site in compliance with AR 25-1 and AR 25-2?
Yes _____
No ______
Don’t know ______
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INSTRUMENT: Attach draft of survey instrument, Memorandum of Instruction to administrators,
and Privacy Act Statement (if applicable).
DATA ANALYSIS PLAN: Describe manner of data processing and statistical procedures to be
used.
DISTRIBUTION OF SURVEY RESULTS: Release of data by the Army Personnel Survey Office:
O Release data to any requestor/media.
O Release data only to those requestors/media specified below:
____________________________________________________________
____________________________________________________________
O Release of data is not desired. Specify reasons:
_____________________________________________________________
_____________________________________________________________
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