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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Generic Clearance Qualitative Feedback_Supporting Statement B.docx	Supporting Statement B	Uploaded 2011-06-14	Available
Generic Clearance Submission Template.docx	Supplementary Document	Uploaded 2011-06-14	Available
Generic Clearance HHS_Supporting Statement A_V2.docx	Supporting Statement A	Uploaded 2011-06-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
212148	Regional Resource Network Program Questionnaire	Other-questionnaire	New
211670	FoodSafety.gov User Satisfaction Survey 2014	Other-List of Questions	New
211532	Healthy People Consortium Customer	Other-survey	New
211186	Food Safety Education Survey	Other-survey	New
210914	SurgeonGeneral.gov Website Visitor Satisfaction Survey	Other-Other	New
210606	HHS Site Search Satisfaction Survey	Other-Other	New
210059	Healthy People.gov Users: Private Sector/State, Local or Tribal Governments/Federal Government	Other-survey	New
208612	HHS HealthBeat Visitor Survey	Other-Other	New
208500	HHS.gov Online Visitor Survey for Mobile and Accessibility	Other-Other	New
208403	Usability.gov Post Release Feedback Survey	Other-Other	New
205993	MentalHealth.gov Website Visitor Satisfaction Survey	Other-Other	New
205301	Usability.gov Customer Satisfaction Survey	Other-Other	New
205152	HHS.gov Developer Online Customer Feedback	Other-Other	New
204928	Usability.gov Website Visitor Satisfaction Survey	Other-Other	New
204194	StopMedicareFraud.gov Website Satisfaction Survey	Other-Other	New
204031	BeTobaccoFree.gov Website Satisfaction Survey	Other-Other	New
203681	eConsent Evaluation Survey	Other-Survey	New
203564	A Public Health Response to Trauma: Creating Conditions, Connection and Community for Women and Families	Other-Customer Comment Card	New
203423	FoodSafety.gov Website Visitor Satisfaction Survey	Other-Other	New
203292	Flu.gov Website Visitor Satisfaction Survey	Other-Questions	New
203270	Vaccines.gov Website Visitor Satisfaction Survey	Other-Other	New
202901	OPEO Webinar Customer Satisfaction Survey	Other-survey	New
202747	Survey Quick Health Data online	Other-form	New
202197	In Person Training/Computer-Based Training	Other-Survey	New
201890	National Women's Health Week	Other-survey	New
201767	HHS.gov Website Visitor Satisfaction Survey	Other-online form	New
201569	StopBullying.gov Website Visitor Satisfaction Survey	Other-online survey	New
200921	Healthcare.gov Visitor Satisfaction Survey	Other-survey	New
200315	Comparative Effectiveness Research Inventory	Other-inventory	New
200221	Provide Services for the Dissemination of CER to Patients and Providers to Increas Adoption- Gutcheck Website Usability Survey	Other-testing	New

ICR Details

OMB Control No: 0990-0379	ICR Reference No: 201106-0990-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/21/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/03/2011
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2014	36 Months From Approved
Responses	1,000,000	0	0
Time Burden (Hours)	67,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable HHS to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with HHS programs.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 80542	12/22/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 25694	05/05/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 30

table that charts list of burden

IC Title	Form No.	Form Name
A Public Health Response to Trauma: Creating Conditions, Connection and Community for Women and Families
BeTobaccoFree.gov Website Satisfaction Survey
Comparative Effectiveness Research Inventory
Flu.gov Website Visitor Satisfaction Survey
Food Safety Education Survey
FoodSafety.gov User Satisfaction Survey 2014
FoodSafety.gov Website Visitor Satisfaction Survey
HHS HealthBeat Visitor Survey
HHS Site Search Satisfaction Survey
HHS.gov Developer Online Customer Feedback
HHS.gov Online Visitor Survey for Mobile and Accessibility
HHS.gov Website Visitor Satisfaction Survey
Healthcare.gov Visitor Satisfaction Survey
Healthy People Consortium Customer
Healthy People.gov Users: Private Sector/State, Local or Tribal Governments/Federal Government
In Person Training/Computer-Based Training
MentalHealth.gov Website Visitor Satisfaction Survey
National Women's Health Week
OPEO Webinar Customer Satisfaction Survey
Provide Services for the Dissemination of CER to Patients and Providers to Increas Adoption- Gutcheck Website Usability Survey
Regional Resource Network Program Questionnaire
StopBullying.gov Website Visitor Satisfaction Survey
StopMedicareFraud.gov Website Satisfaction Survey
SurgeonGeneral.gov Website Visitor Satisfaction Survey
Survey Quick Health Data online
Usability.gov Customer Satisfaction Survey
Usability.gov Post Release Feedback Survey
Usability.gov Website Visitor Satisfaction Survey
Vaccines.gov Website Visitor Satisfaction Survey
eConsent Evaluation Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,000,000	0	0	1,000,000	0	0
Annual Time Burden (Hours)	67,000	0	0	67,000	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: New collection

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Annual Cost to Federal Government: $217,200

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/03/2011

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