CS-11-279 - Generic Clearance

Approval Request for Clearance

Conduct an Appeals Customer Satisfaction Survey (FY 2011)

(OMB Control Number: 1545-1432)

_____________________________________________________________________

Title of Information Collection:

Appeals Customer Satisfaction Survey

Purpose:

The primary goals of the study are to survey Appeals external customers on an ongoing basis regarding their expectations, track customer satisfaction progress over time nationwide, and identify operational improvements.

Type of Collection:

Customer Satisfaction Survey

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:_Rocco D. DiLisio – Analyst__________________________________________

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

3. If Applicable, has a System or Records Notice 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

Estimated Annual Reporting Burden
Type of Collection	No. of Respondents	Annual Frequency per Response	Hours per Response	Total Hours
Screening Participants – Those contacted who did not take the survey	8,400 Approx.	1	1 minute	140
[Household and Private Sector –Completed Surveys]	[4,515]	[1]	[9 minutes]	[677]

Total 817

FEDERAL COST:

The estimated annual cost to the Federal government is: $270,500.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[ X ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ X ] Yes [ ] No