Generic Clearance Submission Template

Generic Clearance Submission Template.docx

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Generic Clearance Submission Template

OMB: 1405-0193

Document [docx]
Download: docx | pdf


Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 1405-0193)


TShape1 ITLE OF INFORMATION COLLECTION:
Visa Applicant Satisfaction Survey


PURPOSE: The form is a customer service survey that will collect information on applicants’ experiences throughout the application and interview processes. The information will be analyzed by posts and used to make improvements in their customer service and application processes.


DESCRIPTION OF RESPONDENTS: Respondents are nonimmigrant and immigrant visa applicants who volunteer to fill out the survey.


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: Lauren Prosnik Visa Specialist, CA/VO/L/R__________________________


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


Category of Respondent

No. of Respondents

Participation Time

Burden

Non-US citizen Visa Applicants

10,000

3 minutes

500 hours





Totals

10,000

3 minutes

500 hours



FEDERAL COST: The estimated annual cost to the Federal government is ____$50,000____


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? [ ] Yes [X] 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?


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

[ X ] In-person

[ X ] Mail

[] Other, Explain


Surveys will be handed out after interviews have concluded, and, depending on the post, available on posts’ websites to be printed out and completed. Applicants will be able to hand the surveys back in person or mail them to posts.


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

Please make sure that all instruments, instructions, and scripts are submitted with the request.

3

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleDOCUMENTATION FOR THE GENERIC CLEARANCE
Author558022
File Modified0000-00-00
File Created2021-02-01

© 2024 OMB.report | Privacy Policy