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

Forms and Documents

Document Name	Status
Form FEMA Form 519-0-16 Post Flood Recovery Survey Form and Instruction	New
Form 519-0-17 DisasterAssistance.gov Satisfaction Survey Form	New
Form FEMA Form 519-0-14 Online Survey Assessing Intergovernmental Affairs Stakeholder's Emergency Management Needs and Preferences Form and Instruction	New
Form FEMA Form 519-0-12 Online Survey Assessing Private Sector Stakeholder's Emergency Management Needs and Preferences Form and Instruction	New
Form FEMA Form 009-0-7 Sheltering Temporary Essential Power (STEP) Form	New
Form FEMA Form 519-0-4 National Fire Academy Level 1 Evaluation Form and Instruction	New
Form FEMA Form 519-0-1 Emergency Management Institute Follow-up Evaluation Survey Form and Instruction	New
Form FEMA Form 092-0-3 Emergency Management Institute Course Evaluation Form Form and Instruction	New
Generic Clearance Submission Template.doc Supplementary Document	2011-10-18
Executive Order 12862.docx Supplementary Document	2011-06-21
1660-NEW 30 Day FRN 6-21-11 docket2011-15361.pdf Supplementary Document	2011-06-21
60 Day PUBLISHED FRN.pdf Supplementary Document	2011-06-21
Part B Supporting Statement 1660-NEW FEMA Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery.docx Supporting Statement B	2011-06-21
Part A Supporting Statement 1660-NEW FEMA Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery.docx Supporting Statement A	2011-06-21

IC Document Collections

IC ID	Document Title	Status
213318	Post Flood Recovery Survey Form and Instruction	New
212648	DisasterAssistance.gov Satisfaction Survey Form	New
211187	Online Survey Assessing Intergovernmental Affairs Stakeholder's Emergency Management Needs and Preferences Form and Instruction	New
211185	Online Survey Assessing Private Sector Stakeholder's Emergency Management Needs and Preferences Form and Instruction	New
210279	Sheltering Temporary Essential Power (STEP) Form	New
208454	Hazard Mitigation Assistance (HMA) Outreach Survey Instruction	New
206105	National Fire Academy Level 1 Evaluation Form and Instruction	New
205768	Emergency Management Institute Follow-up Evaluation Survey Form and Instruction	New
204543	Emergency Management Institute Course Evaluation Form Form and Instruction	New

ICR Details

OMB Control No: 1660-0130	ICR Reference No: 201106-1660-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DHS/FEMA	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: 10/18/2011
	Date Received in OIRA: 08/16/2011
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.”

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2014	36 Months From Approved
Responses	173,800	0	0
Time Burden (Hours)	20,142	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable the Agency 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 the Agency's programs. This feedback will provide insights into customer or stakeholder perceptions, experiences and expectations, provide an early warning of issues with service, or focus attention on areas where communication, training or changes in operations might improve delivery of products or services. These collections will allow for ongoing, collaborative and actionable communications between the Agency and its customers and stakeholders. It will also allow feedback to contribute directly to the improvement of program management.

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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 36139	06/21/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 9

IC Title	Form No.	Form Name
Online Survey Assessing Intergovernmental Affairs Stakeholder's Emergency Management Needs and Preferences	FEMA Form 519-0-14	Online Survey Assessing Intergovernmental Affairs Stakeholder's Emergency Management Needs and Preferences
DisasterAssistance.gov Satisfaction Survey	519-0-17	DisasterAssistance.gov Satisfaction Survey
Emergency Management Institute Course Evaluation Form	FEMA Form 092-0-3	National Emergency Training Center Emergency Management Institute Course Evaluation Form
National Fire Academy Level 1 Evaluation	FEMA Form 519-0-10, FEMA Form 519-0-5, FEMA Form 519-0-6, FEMA Form 519-0-4, FEMA Form 519-0-7	Distance Learning Evaluation ,   End of Course Evaluation ,   Conference/symposium ,   Executive Fire Officer Program (EFOP) ,   Coffe Break Training (CBT) Evaluation
Online Survey Assessing Private Sector Stakeholder's Emergency Management Needs and Preferences	FEMA Form 519-0-12	Online Survey Assessing Private Sector Stakeholder's Emergency Management Needs and Preferences
Post Flood Recovery Survey	FEMA Form 519-0-16, FEMA Form 519-0-16	Post Flooding Recovery Survey - Town Official ,   Post Flooding Recovery Survey - Screen Shots
Sheltering Temporary Essential Power (STEP)	FEMA Form 009-0-7	Sheltering Temporary Essential Power (STEP) Survey
Hazard Mitigation Assistance (HMA) Outreach Survey
Emergency Management Institute Follow-up Evaluation Survey	FEMA Form 519-0-1	Emergency Management Institute Follow-up Evaluation Survey

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ICR Summary 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	173,800	0	0	173,800	0	0
Annual Time Burden (Hours)	20,142	0	0	20,142	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: This is a request for a new generic collection.

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Annual Cost to Federal Government: $1,612,295

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 08/16/2011

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