American Customer Satisfaction Index (ACSI) E-Government Website Customer Satisfaction Surveys

Forms and Documents

Document Name	Status
Form 917 2015 917 Alumni v3 Questionnaire Form and Instruction	New
Form 901 2015 901 CMS Cahaba GBA JJ MAC - 2015 916 USDS FSIS Form and Instruction	New
Form 894 2015 894 EPA Regulations.gov - 2015 900 NASS Satisfaction Survey Form and Instruction	New
Form 892 2014 892 APHIS Biotechnology Regulatory Services Survey - 2014 893 NOAA Fisheries Satisfaction Survey Form and Instruction	New
Form 882 2014 882 CMS Medicare - 2014 891 Treasury Direct v2 Form and Instruction	New
Form 874 2014 874 NCI Team Science Toolkit - 2014 881 Weather.gov Form and Instruction	New
Form 871 2014 871 CG Questionnaire - 2014 873 NLM GHR Questionnaire Form and Instruction	New
Form 865 2014 865 NIAMS - 2014 870 DoDEA Form and Instruction	New
Form 864 2014 864 SSA Main Mobile Survey Form and Instruction	New
Form 842 2014 842 Career State - 2014 863 NIH Grants Form and Instruction	New
Form 819 2014 819 DHS USCIS - 2014 841 VA Medical Centers Form and Instruction	New
Form 810 2014 810 AHRQ Email - 2014 818 MyCareeratVA Form and Instruction	New
Form 809 2014 809 USAjobs Form and Instruction	New
Form 800 2014 800 PSC Milestone Survey - 2014 808 VA eBenefits Form and Instruction	New
Form 798 2014 798 NOAA NGS Renewal - 2014 799 USGS Renewal Form and Instruction	New
Form 794 2014 794 ABMC SiteGov - 2014 797 USPTO CC Survey Form and Instruction	New
Form 783 2014 781 Architect of the U.S. Capitol Gift Shop - 2014 793 FTC Compliant Assistant Survey Form and Instruction	New
Form 779 2014 779 Application Manager - 2014 780 IRS ACA Form and Instruction	New
Form 776 2014 776 CIA - 2014 778 FMCSA Form and Instruction	New
Form 755 2014 755 SSA Diagnostic Survey - 775 USPTO Mobile 2013 Form and Instruction	New
Form 754 2014 754 VA-SEP Form and Instruction	New
Form 748 2014 748 DOC ITA Export gov - 2014 753 USPTO Form and Instruction	New
Form 747 2013 747 Team Science Toolkit Form and Instruction	New
Form 740 2013 740 EFPTS Survey - 2013 U.S. NRC Survey Form and Instruction	New
Form 729 2013 729 Girls Health V2 10-31-13 - 2013 739 NIA Health and Aging 11-5-13 Form and Instruction	New
Form 727 2013 727 IIP Mobile Questionnaire - 2013 728 Onboarding Manager Survey Form and Instruction	New
Form 722 2013 722 CMS NGS DME MAC Questionnaire - 2013 726 MARAD Questionnaire Form and Instruction	New
Form 689 2013 689 NWHLC v2 Questionnaire - 2013 VA Questionnaire_11-26-12 Form and Instruction	New
Form 688 2013 688 USDA-NIFA Questionnaire Form and Instruction	New
Form 687 2013 687 US Dept of State English Questionnaire Form and Instruction	New
Form 659 2013 659 FDA Mobile - 2013 686 VA Medical Centers Form and Instruction	New
Form 658 2013 658 HHS NCI Home Page Site Feedback Form and Instruction	New
Form 637 2013 637 UPSTO Mobile Questionnaire - 2013 657 SBA Questionnaire Form and Instruction	New
Form 635 2013 635 CDFI Fund Questionnaire - 2013 636 Naval HH Questionnaire Form and Instruction	New
Form 626 2013 626 NGS J6 MAC initial survey - 2013 634 USGS v3 Draft Form and Instruction	New
Form 625 613 2013 DOD Defense.gov Questionnaire Form and Instruction	New
Form 622 622 CMS NGS JK MAC Initial Survey - 624 Retirement Services Survey Form and Instruction	New
Form 620 620 NICHD_NCS Model - 621 NIH gov Questionnaire Form and Instruction	New
Form 612 612 E-Verify I-9 Questionnaire - 619 NIJ WoMI Form and Instruction	New
Form 611 2012 611 Crime Solutions (OJP Program) First Survey Form and Instruction	New
Form 610 2012 610 NCCAM Questionnaire 12.31.12.xls Form and Instruction	New
Form 609 609 NIH NCI EGRP Form and Instruction	New
Form 593 2012 593 AHRQ USPSTF Q'naire 11-2-12 - 2012 608 VA for Vets Draft Questionnaire October 2012 Form and Instruction	New
Form 590 590 CQs started 10.5.12 - 592 SEC Questionnaire 10.25.12 Form and Instruction	New
Form 580 562 AHRQ Enterprise_9-10-12_UPDATED - 589 CDC SM Posting Survey Form and Instruction	New
Form 541 541 Alzheimer's Questionnaire - 561 VA-eBenefits Questionnaire Form and Instruction	New
Form 533 533 CQs for OMB started 5-3-12 - 540 USPTO 5-14-12 Form and Instruction	New
Form 516 516 CQs for OMB - 532 VBA Survey Form and Instruction	New
Form 497 MakingHome 488 USGS Gap Analysis - 515 SSA Electronic Access Form and Instruction	New
Form VA e-Benefits Previously Cleared ICs from prior Generic ICR Form and Instruction	New
2011-1090-0008 FSR 30-Day Notice Published.pdf Supplementary Document	2011-11-21
SS Part A 1090-0008 11.9.11.docx Supporting Statement A	2011-11-10
List_of_Custom_ForeSee_Results_ACSI_Questions_11-10-11.xlsx Supplementary Document	2011-11-10
60 Day Notice 1090-0008--7.25.11--76 FR 44351.pdf Supplementary Document	2011-10-25
SS Part B for 1090-0008 10.13.11.doc Supporting Statement B	2011-10-14
CFI_ACSI Methodology in Mgmt of Govt Svcs Merz paper.pdf Supplementary Document	2008-09-25
ACSI Methodology Paper.pdf Supplementary Document	2008-09-25
Executive Order 12862.htm Supplementary Document	2008-09-25
List of Standard ForeSee Results ACSI Questions.xls Supplementary Document	2008-09-25

IC Document Collections

IC ID	Document Title	Status
215140	2015 917 Alumni v3 Questionnaire Form and Instruction	New
214851	2015 901 CMS Cahaba GBA JJ MAC - 2015 916 USDS FSIS Form and Instruction	New
214621	2015 894 EPA Regulations.gov - 2015 900 NASS Satisfaction Survey Form and Instruction	New
214367	2014 892 APHIS Biotechnology Regulatory Services Survey - 2014 893 NOAA Fisheries Satisfaction Survey Form and Instruction	New
214140	2014 882 CMS Medicare - 2014 891 Treasury Direct v2 Form and Instruction	New
213811	2014 874 NCI Team Science Toolkit - 2014 881 Weather.gov Form and Instruction	New
213560	2014 871 CG Questionnaire - 2014 873 NLM GHR Questionnaire Form and Instruction	New
213422	2014 865 NIAMS - 2014 870 DoDEA Form and Instruction	New
213313	2014 864 SSA Main Mobile Survey Form and Instruction	New
213084	2014 842 Career State - 2014 863 NIH Grants Form and Instruction	New
212646	2014 819 DHS USCIS - 2014 841 VA Medical Centers Form and Instruction	New
212444	2014 810 AHRQ Email - 2014 818 MyCareeratVA Form and Instruction	New
212143	2014 809 USAjobs Form and Instruction	New
211785	2014 800 PSC Milestone Survey - 2014 808 VA eBenefits Form and Instruction	New
211712	2014 798 NOAA NGS Renewal - 2014 799 USGS Renewal Form and Instruction	New
211482	2014 794 ABMC SiteGov - 2014 797 USPTO CC Survey Form and Instruction	New
211324	2014 781 Architect of the U.S. Capitol Gift Shop - 2014 793 FTC Compliant Assistant Survey Form and Instruction	New
211041	2014 779 Application Manager - 2014 780 IRS ACA Form and Instruction	New
210740	2014 776 CIA - 2014 778 FMCSA Form and Instruction	New
210413	2014 755 SSA Diagnostic Survey - 775 USPTO Mobile 2013 Form and Instruction	New
210238	2014 754 VA-SEP Form and Instruction	New
210083	2014 748 DOC ITA Export gov - 2014 753 USPTO Form and Instruction	New
209997	2013 747 Team Science Toolkit Form and Instruction	New
209719	2013 740 EFPTS Survey - 2013 U.S. NRC Survey Form and Instruction	New
209296	2013 729 Girls Health V2 10-31-13 - 2013 739 NIA Health and Aging 11-5-13 Form and Instruction	New
209069	2013 727 IIP Mobile Questionnaire - 2013 728 Onboarding Manager Survey Form and Instruction	New
208894	2013 722 CMS NGS DME MAC Questionnaire - 2013 726 MARAD Questionnaire Form and Instruction	New
208752	2013 689 NWHLC v2 Questionnaire - 2013 VA Questionnaire_11-26-12 Form and Instruction	New
208547	2013 688 USDA-NIFA Questionnaire Form and Instruction	New
208491	2013 687 US Dept of State English Questionnaire Form and Instruction	New
208264	2013 659 FDA Mobile - 2013 686 VA Medical Centers Form and Instruction	New
208123	2013 658 HHS NCI Home Page Site Feedback Form and Instruction	New
207810	2013 637 UPSTO Mobile Questionnaire - 2013 657 SBA Questionnaire Form and Instruction	New
207594	2013 635 CDFI Fund Questionnaire - 2013 636 Naval HH Questionnaire Form and Instruction	New
207064	2013 626 NGS J6 MAC initial survey - 2013 634 USGS v3 Draft Form and Instruction	New
206824	613 2013 DOD Defense.gov Questionnaire Form and Instruction	New
206746	622 CMS NGS JK MAC Initial Survey - 624 Retirement Services Survey Form and Instruction	New
206217	620 NICHD_NCS Model - 621 NIH gov Questionnaire Form and Instruction	New
206075	612 E-Verify I-9 Questionnaire - 619 NIJ WoMI Form and Instruction	New
205548	2012 611 Crime Solutions (OJP Program) First Survey Form and Instruction	New
205320	2012 610 NCCAM Questionnaire 12.31.12.xls Form and Instruction	New
205170	609 NIH NCI EGRP Form and Instruction	New
204993	2012 593 AHRQ USPSTF Q'naire 11-2-12 - 2012 608 VA for Vets Draft Questionnaire October 2012 Form and Instruction	New
204629	590 CQs started 10.5.12 - 592 SEC Questionnaire 10.25.12 Form and Instruction	New
204414	562 AHRQ Enterprise_9-10-12_UPDATED - 589 CDC SM Posting Survey Form and Instruction	New
204134	541 Alzheimer's Questionnaire - 561 VA-eBenefits Questionnaire Form and Instruction	New
202706	533 CQs for OMB started 5-3-12 - 540 USPTO 5-14-12 Form and Instruction	New
201861	516 CQs for OMB - 532 VBA Survey Form and Instruction	New
201702	488 USGS Gap Analysis - 515 SSA Electronic Access Form and Instruction	New
199748	Previously Cleared ICs from prior Generic ICR Form and Instruction	New

ICR Details

OMB Control No: 1090-0008	ICR Reference No: 201110-1090-001
Status: Historical Active	Previous ICR Reference No: 201101-1090-002
Agency/Subagency: DOI/ASPMB	Agency Tracking No: 1090-0008
Title: American Customer Satisfaction Index (ACSI) E-Government Website Customer Satisfaction Surveys
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/26/2012
	Date Received in OIRA: 11/21/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2015	36 Months From Approved	03/31/2012
Responses	4,125,000	0	1,520,000
Time Burden (Hours)	171,875	0	62,917
Cost Burden (Dollars)	0	0	0

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Abstract: The objectives of surveying citizen users of federal agency websites are to: (1) provide information for improving the quality of and satisfaction with agency websites: (2) ensure continuous assessment and improvement capabilities; (3) benchmark results against other agencies and private companies; (4) determine how different types of changes to the websites will impact future citizen behaviors; and (5) make the agencies part of a quarterly E-Government customer satisfaction benchmark and annual index for all measured Federal Government activities.

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Authorizing Statute(s): None

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:
	76 FR 44351	07/25/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 71997	11/21/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 50

IC Title	Form No.	Form Name
613 2013 DOD Defense.gov Questionnaire	625	2013 625 DOD Defense.gov Questionnaire
2013 689 NWHLC v2 Questionnaire - 2013 VA Questionnaire_11-26-12	711, 714, 715, 721, 692, 693, 694, 695, 696, 697, 699, 705, 706, 689, 690, 691, 698, 700, 701, 702, 703, 704, 707, 708, 709, 710, 713, 720, 712, 716, 717, 718, 719	2013 689 NWHIC V2 Questionnaire ,   2013 690 SAMHSA Main Qst 7.30.13 ,   2013 691 BEA CQ revisions_Feb2011 ,   2013 692 Careers.state.gov CQ changes 7-29-13 ,   2013 693 CDC Questionnaire 3.29.2012 ,   2013 694 CHCO Abandoner Survey v3 ,   2013 695 CHCO Completer v3 ,   2013 696 CHCO Post-Completers v3 ,   2013 697 DOJ - BJS Questionnaire ,   2013 698 DOL Doors August 2012 ,   2013 699 ERS Questionnaire 7-2013 ,   2013 700 FAA Questionnaire Feb 2013 ,   2013 701 FDIC App V# CQ changes 8-13-13 ,   2013 FDIC Main V2 as of August 8 2013 ,   2013 703 FTC ComplaintAssistant Qnaire 6-21-2013 ,   2013 704 FTC OnGuardOnline Qnaire 7-28-11 ,   2013 705 FTC.gov Questionnaire 3-9-2012 ,   2013 706 GAO Questionnaire 3.19.13 ,   2013 707 IRS Questionnaire v2 8-27-2012 ,   2013 708 Library of Congresws CQ changes 7-17-13 ,   2013 709 MyHealthVet Survey May 2013 ,   2013 710 NARA Archives 10-23-12 ,   2013 711 NIDCR English qnaire ,   2013 712 NIDCR Spanish 9-06-2012 ,   2013 713 NIJV2 CQ Change update ,   2013 714 OPM 6MM v2 8-23-13 ,   2013 715 OPM Manager Survey 10-1-2013 ,   2013 716 UNICOR Survey Questionnaire 1.31.12 ,   2013 717 US Embassy Enterprise V2 Questionnaire 7-12-11 ,   2013 718 USAJobs 1.6.2012 ,   2013 719 USTIC v2 March 2013 w email cq ,   2013 720 USTTB V2 CQ CHANGES 8-20-13 ,   2013 721 VA Questionnaire 11-26-12
590 CQs started 10.5.12 - 592 SEC Questionnaire 10.25.12	590 , 591, 592	590 CQs for OMB started 10.5.12 ,   591 NLM Clinical Trials Site Feedback 10.18.12 ,   592 SEC Questionnaire 10.25.12
533 CQs for OMB started 5-3-12 - 540 USPTO 5-14-12	533, 534, 535, 536 , 537, 538, 539, 540	533 CQs for OMB started 5-3-12 ,   534 FDIC Application Questionnaire 7-01-2012 ,   535 FDIC Questionnaire 7-01-2012 ,   536 GSA Agencywide v3 5-7-2012 ,   537 gsa.gov Agencywide v4 5-10-12 ,   538 Heathfinder v2 5-24-12 ,   539 PBGC Perception 5-3-12 ,   540 USPTO 5-14-12
Previously Cleared ICs from prior Generic ICR	VA e-Benefits, 408 RegInfo, 417 HowTo, 420 CQs, 421 DHHS PSC, 422 DOT, 425 FEMA, 426 NIST, 378 CQs, 484 Healthfinder, 439 FMCSA, 385 CVC, 384 PSC, 362 Medicare, 305 State Careers, 304 DOT NHTSA, 443 CQs, 457 CQs, 377 USPTO, 313 CDC Mobile, 485 NIAID, 486 PBGC, DHS CIS, 271 Treas IRS, 267 HHS NIDCR, NLM OSA 4-1-09, 273 OnGuardOnLine, 427 CQs, 424 AHRQ, 431 CQs, 432 FEMA, 433 BenefitsGov, 405 CQs 1-11-11, 387 CQs, 314 CQs, 306 CQs, 394 DHS CIS, 393 CQs, 382 FCA, 372 PBGC, 365 CPSC, 363 NIH, 350 FDA, 343 Census, 344 CQs, 383 FedsHireVets, 301 DoD AF, 293 DHS CIS Welcome, 290 CQs, 473 SSA, 404 VOA, 311 CQs, 406 GSA, 459 US Courts, 458 NICHD, 460 US Embassies, 461 CMS, 463 DoD, 471 Health IT, 472 CQs, Redesign CQs, 414 ePSS, 280 CMS FCSO CQs, 276 EPA New Model, 260 Obama Directive, 265 FTC Comp Asst, 479 CQs, 345 NIH NIGMS, 400 NGS NOAA, 407 GSA, 299 State IIP, 292 DHS CIS Spanish, 302 CQs, 281 State Mobile, 247 DoD AF, 401 CDC, 340 DOT, 334 NRC, 418 NLM, 462 CQs, 339 CQs, 333 CQs, 322 CQs, 312 CQs, 398 CQs, FEMA Dis Asst, 346 DoD Navy, AHRQ CAHPS, CFTC v2, CitizenFeedback, 423 DOJ, 370 MyMoney, 369 GobiernoUSA, 366 CQs, 324 VBA, 289 NIH Genome, 283 Master Questions List, 277 FEMA Main , 275 CQs NCI, 274 CQs CMS, 309 ResearchGov, 478 FSIS, 483 CQs, 349 CQs, 310 RRB, 392 USTTB CQs, 364 RE and S-RE, 300 CQs, 291 DHS CIS, 287 CQs, 316 FDIC, 323 SSA, 315 DHS CBP, 348 CPSC, 347 DOT Intranet, 399 NIDCR, 263 Social Media Quest, State Travel, 416 FCIC, 415 FCIC, 419 CMS, 286 HHS ONC, 282 DHS New Model, 386 DOJ, 487 SSA, 285 DHS CIS E Vfy, 373 CQs, 371 NLM, 440 FMCSA, 441 FMCSA, 481 FBI	VA e-Benefits ,   CFTC v2 ,   350 FDA 8-11-10 ,   349 CQs 8-9-10 ,   348 CPSC ,   347 DOT Intranet ,   346 DoD Navy ,   345 NIH NIGMS ,   344 CQs 7-19-10 ,   343 Census ,   339 CQs 7-6-10 ,   340 DOT ,   334 NRC ,   333 CQs 6-8-10 ,   324 VBA ,   323 SSA Policy Pages ,   322 CQs 5-19-10 ,   316 FDIC CQs ,   315 DHS CBP ,   314 CQs 5-3-10 ,   313 CDC Mobile ,   290 CQs 12-4-09 ,   312 CQs 4-14-10 ,   310 RRB ,   311 CQs 3-29-10 ,   306 CQs 3-2-10 ,   305 State Careers v2 ,   304 DOT NHTSA ,   302 CQs 2-5-10 ,   301 DoD AF v2 ,   300 CQs 1-16-10 ,   299 State IIP Embassy ,   292 DHS CIS Spanish ,   293 DHS CIS Welcome ,   291 DHS CIS ,   289 NIH Genome ,   286 CQs 11-16-09 ,   286 HHS ONC ,   285 DHS CIS E Vfy ,   283 Master Questions List as of 11-17-09 ,   281 State Mobile ,   282 DHS New Model 11-6-09 ,   280 CMS FCSO CQs ,   277 FEMA Main v2 ,   276 EPA New Model ,   275 CQs NCI ,   274 CQs CMS ,   309 ResearchGov ,   AHRQ CAHPS ,   398 CQs ,   399 NIDCR English 2011 ,   400 NGS NOAA ,   401 CDC ,   404 VOA ,   405 CQs 1-11-11 ,   406 GSA Auctions ,   407 GSA Xcess ,   408 RegInfo ,   414 ePSS Wave 1 ,   415 FCIC Cons Action CQs ,   416 FCIC Pueblo ,   417 HowTo ,   418 NLM Clinical Trials ,   419 CMS Palmetto GBA J11 MAC ,   420 CQs 2-4-11 ,   421 DHHS PSC Offline ,   422 DOT FHWA ,   423 DOJ COPS Pub Mo ,   424 AHRQ Eff Health Care ,   425 FEMA Mobile ,   426 NIST Sat v 3-28-11 ,   427 CQs 3-25-11 ,   431 CQs 4-8-11 ,   432 FEMA ReadyGov ,   433 BenefitsGov ,   439 FMCSA Passenger Carrier ,   440 FMCSA Protect Your Move ,   441 FMCSA v2 ,   443 CQs 4-28-11 ,   457 CQs 5-17-11 ,   458 NICHD ,   459 US Courts ,   460 US Embassies Enterprise ,   461 CMS Medicare Plan Finder ,   462 CQs 6-14-11 ,   463 Dod Enterprise ,   471 Health IT ,   472 CQs 7-8-11 ,   473 SSA iClaim v2 ,   478 FSIS Intranet ,   CitizenFeedback ,   DHS CIS Welcome ,   FEMA Disaster Assistance ,   247 DoD Air Force ,   260 Obama Directive ,   265 FTC Complaint Assistant ,   271 Treas IRS ,   267 HHS NIDCR Spanish CQs ,   NLM OSA 4-1-09 ,   479 CQs 7-26-11 ,   481 FBI v3 ,   483 CQs 9-15-11 ,   484 Healthfinder v2 ,   485 NIAID ,   362 Medicare ,   486 PBGC v3 ,   487 SSA Extra Help v2 Eng Equiv ,   394 DHS CIS Citizenship Resource Center ,   393 CQs 11-29-10 ,   392 USTTB CQs ,   387 CQs 11-3-10 ,   386 DOJ BJS ,   385 CVC ,   384 DHHS PSC ,   383 OPM FedsHireVets ,   382 FCA ,   378 CQs 10-17-10 ,   377 USPTO Revised ,   373 CQs 9-21-10 ,   372 PBGC My PAA v3 ,   371 NLM Exhibition ,   370 MyMoney ,   369 GobiernoUSA ,   366 CQs 8-25-10 ,   365 CPSC ,   364 RE and S-RE ,   363 NIH NIDCD ,   273 FTC OnGuardOnLine ,   Redesign CQs ,   263 Social Media Questions ,   State Travel
2015 894 EPA Regulations.gov - 2015 900 NASS Satisfaction Survey	897, 895, 898, 894, 896, 899, 900	2015 894 EPA Regulations.gov ,   2015 895 FBI ,   2015 896 OPM On Boarding Manager ,   2015 897 U.S. Department of Education ,   2015 898 USPTO ,   2015 899 USPTO Mobile ,   2015 900 NASS Satisfaction Survey
2014 874 NCI Team Science Toolkit - 2014 881 Weather.gov	874, 875, 877, 880, 881, 876, 878, 879	2014 874 NCI Team Science Toolkit ,   2014 875 NHWIC Girlshealth ,   2014 876 NIH NIA Alzheimers Browse ,   2014 877 NPS Renewal ,   2014 NWHIC Womenshealth ,   2014 879 SAMSHA ,   2014 880 SAMSHA Store ,   2014 881 Weather.gov
2014 842 Career State - 2014 863 NIH Grants	843, 844, 846, 847, 850, 851, 853, 861, 863, 842, 848, 845, 852 , 855, 854, 856, 857, 858, 859, 860, 862, 849	2014 842 Careers State ,   2014 843 CDC ,   2014 844 DOJ NIJ ,   2014 845 FAA ,   2014 846 FDIC Applications ,   2014 847 FDIC Main ,   2014 848 FTC Complaintassistant ,   FTC Main ,   2014 850 FTC Onguradonline ,   OPM Abandoners ,   2014 OPM Completers ,   2013 853 OPM Managers ,   2014 OPM Post Completers ,   2014 866 State Embassy Enterprise ,   2014 856 TTB ,   2014 857 UNICOR ,   2014 858 USAJOBS ,   2014 859 USITC ,   2014 860 VA ,   2014 861 VA-MyHealtheVet ,   2014 862 FEC Web Browse ,   2014 863 NIH Grants
2014 754 VA-SEP	754	2014 754 VA-SEP
2015 901 CMS Cahaba GBA JJ MAC - 2015 916 USDS FSIS	906, 907, 908, 909, 910, 911, 913, 914, 915, 916, 904, 901, 902, 903, 905, 912	2015 901 CMS - Cahaba GBA JJ MAC ,   2015 902 CMS Compare ,   2015 903 Disability.gov ,   2015 904 GSA Auctions ,   2015 905 DOT RITA ,   2015 905 Healthfinder ,   2015 907 Healthypeople ,   2015 908 Labor Union Reports ,   2015 909 NCJRS (OJP Program) ,   2015 910 OJP BJA ,   2015 911 OJP Main ,   2015 912 OJP OJJDP ,   2015 913 OJP OVC ,   2015 914 Treasury MHA Renewal ,   2015 915 TreasuryDirect ,   2015 916 USDA FSIS
622 CMS NGS JK MAC Initial Survey - 624 Retirement Services Survey	623, 622, 624	2013 622 CMS NGS JK MAC initial survey ,   2013 623 PBGC Customer Sat v2Qnaire ,   2013 624 Retirement Services Survey
2014 871 CG Questionnaire - 2014 873 NLM GHR Questionnaire	871, 872, 873	2014 871 CG Questionnaire ,   2014 872 FEC Web Browse ,   2014 873 NLM GLR Questionnaire
2013 659 FDA Mobile - 2013 686 VA Medical Centers	664, 671, 659, 660 , 661, 662, 663, 665 , 666, 667, 668, 669, 670 , 672, 673, 674, 675, 676, 677, 678, 679, 680, 681, 682, 683, 684, 685, 686	2013 659 FDA Mobile ,   2013 660 NOAA NOS CO-OPS ,   2013 661 Alumni Questionnaire Master ,   2013 662 BSO v2 ,   2013 663 CFTC V2 Questionnaire ,   2013 664 DHS CIS Spanish ,   2013 665 Disability v2 ,   2013 666 DOT Intranet ,   2013 667 EPA Questionnaire ,   2013 668 Exchanges v2 Questionnaire ,   2013 669 ExtraHelp v3 with Spanish Translations ,   2013 FRA Questionnaire ,   2013 671 FulBright Questionnaire ,   2013 672 iClaims v3 ,   2013 673 main v3 ,   2013 674 MedlinePlus Mobile ,   2013 675 MedlinePlus Survey Spanish ,   2013 676 MedlinePlus Survey ,   2013 677 My Social Security v2 CQ changes ,   2013 678 NIDDK Questionnaire ,   2013 679 NIH NIAD ,   2013 680 NLA Main Site CQ change ,   2013 681 NLM Clinical Trails Site Feedback ,   2013 682 Retirement Estimator v4 with Spanish Translations ,   2013 683 SSA FAQ v3 ,   2013 684 USCIS CQ Changes ,   2013 685 VBA Survey ,   2013 686 VHA Medical Centers Questionnaire Redesign Questions
2014 864 SSA Main Mobile Survey	864	2014 SSA Main Mobile Survey
2013 722 CMS NGS DME MAC Questionnaire - 2013 726 MARAD Questionnaire	723, 722, 724, 725, 726	2013 722 CMS NGS DME MAC ,   2013 723 NASA 1-21-13_September ,   2013 724 NIAMS Questionnaire ,   2013 725 Alumni Questionnaire Master ,   2013 726 MARAD Questionnaire
541 Alzheimer's Questionnaire - 561 VA-eBenefits Questionnaire	541, 542, 543, 547, 544, 545, 546, 548, 549, 550, 551, 552, 553 , 554, 555, 556 , 557, 559, 560, 561, 558	541 Alzheimers Questionaire ,   543 Cahaba J10 MAC Survey ,   544 CMS Novitas JH MAC ,   545 CMS Cahaba J10 MAC ,   546 CMS WPS J8 MAC Questionnaire ,   547 CQs for OMB started 6-7-2012 ,   548 CVC Tour 8-21-12 ,   549 Dept of State v2 8-17-12 ,   550 DHHS PSC Offline v2 8-13-12 ,   551 DOJ ATF 7-24-12 ,   552 DOL Doors August 2012 ,   553 FDA Browse 6-27-12 ,   554 NHTSA 6.27.12 ,   555 NHTSA 8.27.12 DOT ,   556 NIJ NIJ v2 9-1-12 ,   557 PBGC.gov v3 Questionnaire 8-15-12 ,   558 PBGC Perception Questionnaire ,   559 Recreation.gov Questionnaire 8-28-12 ,   560 SaferCar Questionnaire June 2012 ,   561 VA eBenefits Questionnaire 8-29-12 ,   Alzheimers AOA
2013 727 IIP Mobile Questionnaire - 2013 728 Onboarding Manager Survey	727, 728	2013 727 IPP Mobile Questionnaire ,   2013 728 Onboarding Manager Survey
612 E-Verify I-9 Questionnaire - 619 NIJ WoMI	612, 613, 614 , 615, 616, 617, 618, 619	2013 612 E-Verify I-9 Questionnaire ,   2013 613 E-Verify I-9 Questionnaire ,   2013 614 E-Verify SAVE Questionnaire ,   2013 615 E-Verify Self-Check Questionnaire ,   2013 616 E-Verify Self-Check SP Questionnaire ,   2013 617 E-Verify SP Questionnaire ,   2013 618 NIAMS SiteFeedback Questionnaire ,   2013 619 NIJ WoMI
2013 747 Team Science Toolkit	747	2013 747 Team Science Toolkit
2014 779 Application Manager - 2014 780 IRS ACA	780, 779	2014 779 Application Manager ,   2014 780 IRS ACA
2014 755 SSA Diagnostic Survey - 775 USPTO Mobile 2013	768, 769, 770, 771, 773, 774, 775, 763, 766, 772, 756, 755, 757, 758, 759, 760, 761, 762, 764, 765, 767	2014 755 SSA Diagnostic Survey ,   2014 756 CMS Compare Enterprise ,   2014 Disability.gov Renewal ,   2014 758 DOJ BJA (OJP Program) ,   2014 759 DOJ NCJRS (OJP Program) ,   2014 760 DOJ OJJDP (OJP Program) ,   2014 761 DOJ Main (OJP Program) ,   2014 762 DOJ OVC (OJP Program) ,   2014 775 USPTO Mobile 2013 ,   2014 763 DOT Intranet ,   2014 764 DOT MAIN 2013 ,   2014 765 DOT RITA Renewal 2013 ,   2014 766 GSA Auctions 2013 ,   2014 767 GSA Govsales 2013 ,   2014 768 HHS ODPHP Healthfinder 2013 ,   2014 769 HHS ODPHP Healthypeople 2013 ,   2014 770 Labor Union Reports Renewal 2013 ,   2014 771 NASA Main Renewal 2013 ,   2014 772 Treasury NHA Renewal 2013 ,   2014 773 TreasuryDirect 2013 ,   2014 774 USDA FSIS Renewal 2013
2014 819 DHS USCIS - 2014 841 VA Medical Centers	819, 820, 821, 822, 823, 824, 825, 826, 827, 828, 829, 830, 831 , 832, 833, 834, 835, 836, 837, 838, 839, 841, 840	2014 819 DHS USCIS ,   2014 820 DHS USCIS Spanish ,   2014 821 DOT FRA ,   2014 822 OOT TREAS-CDFI Fund ,   2014 823 EPA ,   2014 824 NIH NIAID ,   2014 825 NLM Clinical Trails ,   2014 826 NLM Clinical Trials SiteFeedback ,   2014 827 NLM Main ,   2014 828 SSA BSO ,   2014 829 SSA Diagnostic formerly FAQ ,   2014 830 SSA Disability Report ,   2014 831 SSA Extra Help ,   2014 832 SSA iAppeal 2013 ,   2014 833 SSA iAppeals 2012 ,   2014 834 SSA iClaim2013 ,   2014 835 SSA Main ,   2014 836 SSA Mobile Wage ,   2014 837 SSA MySSA ,   2014 838 SSA Retirement Estimator ,   2014 839 State ECA Alumni ,   2014 840 VA VBA ,   2014 841 VHA Medical Centers
2014 800 PSC Milestone Survey - 2014 808 VA eBenefits	802, 801, 803, 804, 805, 806, 807, 808, 800	2014 800 PSC Milestone Survey ,   2014 801 US Mint Mobile Survey ,   2014 802 Benefits.gov ,   2014 803 BLS ,   2014 804 Forest Service Enterprise ,   2014 805 NFS Renewal ,   2014 806 Travel State ,   2014 807 Treasury Main ,   2014 808 VA eBenefits
2012 611 Crime Solutions (OJP Program) First Survey	611	2012 611 Crime Solutions (OJP Program) First Survey 1-25-13
2014 865 NIAMS - 2014 870 DoDEA	865, 868, 869, 870 , 866, 867	2014 865 NIAMS ,   2014 866 NRCS Satisfaction Survey ,   2014 867 OPM Six-Month Manager ,   2014 868 PSC ,   2014 869 PSC Email ,   2014 870 DoDEA
2013 637 UPSTO Mobile Questionnaire - 2013 657 SBA Questionnaire	657, 639, 643, 642, 644, 645, 646 , 647, 648, 649, 650, 651, 654, 637, 638, 640, 641, 652, 653, 655, 656	2913 637 USPTO Mobile Questionnaire ,   2013 638 Benefits.gov ,   2013 639 BLS Full Site ,   2013 FEMA DisasterAssistance ,   2013 641 FEMA Mobile Survey ,   2013 642 FEMA Readygov ,   2013 643 FEMAv2 2-28-2013 ,   2013 644 Travel State Questionnaire ,   2013 US Forest Svc Enterprise ,   2013 646 US Treasury Questionnaire ,   2013 647 V@ Research.gov Questionnaire ,   2013 648 AHRQ e-mail ,   2013 649 AHRQ Enterprise ,   2013 650 Dept of state ,   2013 651 DOD Defense.gov Questionnaire ,   2013 652 DoD Enterprise Questionnaire ,   2013 653 DOS Blogs Questionnaire ,   2013 654 DOT Main redesign ,   2013 655 Grants.gov questionnaire ,   2013 656 NICHD NCS Model ,   2013 657 SBA Questionnaire
2013 687 US Dept of State English Questionnaire	687	2013 687 Dept of State English Questionnaire
2013 626 NGS J6 MAC initial survey - 2013 634 USGS v3 Draft	627, 626, 628, 629, 630, 631, 633, 634, 632	2013 626 CMS NGS J6 MAC initial survey ,   2013 627 CMS - Novitas JL MAC (5-20-13 initial survey) ,   2013 628 IRS Spanish Questionnaire 5-13-2013 FINAL ,   2013 629 Mullen Questionnaire Todaysmilitary 11-27-12 ,   2013 630 Mullen Questionnaire_MyFuture.com V2 5-7-12 ,   2013 631 OFS Questionnaire 5-21-13 ,   2013 632 Questionnaire ABMC 3-1-2013_DOT ,   2013 633 Questionnaire_NGSNOAA 5-20-13_DOT ,   2013 634 USGS v3 Draft 10-10 2012_DOT
2015 917 Alumni v3 Questionnaire	917, 918, 919	2015 917 Alumni v3 Questionnaire ,   2015 918 Fiscal Service Questionnaire ,   2015 919 MyUSCIS Questionnaire
2013 688 USDA-NIFA Questionnaire	688	2013 688 USDA-NIFA Questionnaire
2014 809 USAjobs	809	2014 809 USAjobs
609 NIH NCI EGRP	609	2012 609 NIH NCI EGRP
2012 610 NCCAM Questionnaire 12.31.12.xls	610	2012 610 NCCAM Questionnaire 12.31.12
2013 635 CDFI Fund Questionnaire - 2013 636 Naval HH Questionnaire	635, 636	2013 635 CDFI Fund Questionnaire ,   2013 636 Naval HH Questionnaire
2012 593 AHRQ USPSTF Q'naire 11-2-12 - 2012 608 VA for Vets Draft Questionnaire October 2012	593, 594, 595, 596, 597, 598, 599, 600, 601, 602, 603, 604, 605, 606, 607, 608	2012 593 AHRQ USPSTF Q'naire 11-20-12 ,   2012 594 BJA (OJP Program) 11.27.12 ,   2012 595 Compare Web Sites Nov 27 2012 ,   2012 596 ECA Bureau Site Questionnaire Draft 10-25-12 ,   2012 597 IRS Spanish Questionnaire 11-28-12 ,   2012 598 MyCareeratVA questionnaire 11.26.12 ,   2012 599 NCJRS (OJP Program) 11-21.12 ,   2012 600 NLM Exhibition Survey 11-28-12 ,   2012 601 OJJDP (OJP Program) 11-6-12 ,   2012 602 OJP Main 11-20-12 ,   2012 603 OVC (OJP Program) 11-25-12 ,   2012 604 SMART (OJP Program) 11-12 ,   2012 605 US Forest Svc_Enterprise-NF&G 11-13 Final ,   2012 606 US Forest Svc_Enterprise-R&D 11-16-12 Final ,   2012 607 US Forest Svc_Enterprise-S&PF 11-26-12 ,   2012 608 VA for Vets Draft Questionnaire October 2012
516 CQs for OMB - 532 VBA Survey	517, 519, 520, 521, 516, 518, 523, 525, 531, 522, 524, 526, 527, 528, 529, 530, 532	516 CQs for OMB started 3-16-2012 ,   517 Department of State_Main v2 3-26-12 ,   518 IRS Transcript Survey 3-14-12 Final ,   519 NRCS_Qnaire_v2_3-16-12_Final ,   520 Small Business Administration 3-16-12 ,   521 SSA Electronic Access 4-2-12 ,   522 CMS Palmetto GBA J11 Mac 4-6-11.xlsx ,   523 CMS Palmetto J1 MAC 4-9-12.xlsx ,   524 CMS Palmetto Railroad 4-6-12.xlsx ,   525 CQs for OMB started 4-4-2012 ,   526 EPA Questionnaire April 27 2012.xlsx ,   FDIC Applications 4-20-12.xlsx ,   528 FDIC Main v2 4-24-12.xlsx ,   529 Financial Stability Survey 4-16=12.xlsx ,   530 Regulations gov 5-1-12.xlsx ,   531 USTTB 4-17-12.xlsx ,   532 VBA Survey 4-30-12.xlsx
2014 798 NOAA NGS Renewal - 2014 799 USGS Renewal	799, 798	2014 798 NOAA NGS Renewal ,   2014 799 USGS Renewal
2014 794 ABMC SiteGov - 2014 797 USPTO CC Survey	794, 795, 796, 797	2014 794 ABMC SiteGov ,   2014 795 Treasury OFS Renewal ,   2014 796 USDA FNS Premium Enterprise ,   2014 797 USPTO Survey
2013 658 HHS NCI Home Page Site Feedback	658	2013 658 HHS NCI Home Page Site Feedback Qnaire
2013 740 EFPTS Survey - 2013 U.S. NRC Survey	741, 744, 745, 746, 740, 742, 743	2013 EFTPS Survey 12-16-13 ,   2013 741 CMS Medicare Plan Finder 11-11-13 ,   2013 742 CMS Noridian DME 11-8-13 ,   2013 743 DOD TRICARE 11-30-13 ,   2013 744 HHS OCR 11-16-13 ,   2013 745 NRSS Recreation Gov 11-30-13 ,   2013 746 U.S. NRC Satisfaction Survey v2 11-30-13
620 NICHD_NCS Model - 621 NIH gov Questionnaire	620, 621	2013 620 NICHD_NCS Model ,   2013 621 NIH gov Questionnaire
2014 776 CIA - 2014 778 FMCSA	778, 777, 776	2014 776 CIA 2-12-28 ,   2014 777 DOJ Crime Solutions (OJP Program) 2-18-14 ,   2014 778 FMCSA 2-28-14
562 AHRQ Enterprise_9-10-12_UPDATED - 589 CDC SM Posting Survey	579, 580, 581, 565, 582, 583 , 584, 585, 586, 587, 588, 589, 562, 563, 564, 566, 567, 568, 569, 570, 571, 573, 572, 574, 575, 576, 577, 578	580 PBGC-PBGC.gov v4 D1 9-20-2012 ,   581 SaferCar Questionnaire 9-14-12 ,   562 AHRQ Enterprise 9-10-12 UPDATED ,   563 AHRQ Quality Measures Q'naire 9-13-2012 ,   564 Census Questionniare_Template 9-5-12 ,   566 CMS-NAS-DME MAC Qnaire 8-22-2012 ,   567 DOL Union Reports V2 model ,   568 DOL Union Reports V2_09242012_DOT ,   569 EA OSSS Questionnaire 10-02-2012 ,   570 Exchanges v2 Questionnaire 9-14-2012 ,   571 Export.gov questionnaire Oct2 ,   572 FBI V3 Questionnaire 9-19-2012 ,   573 FDA Browse Survey 9-17-2012 ,   574 Freddie Mac V3 9.4.2012 ,   575 gsa.gov Agencywide V6_DOT ,   576 Healthypeople.gov Survey 9.18.2012 ,   577 Medicare Questionnaire Sept 26 2012 FINAL ,   578 MyPBA v2 Qnaire 9-21-12 ,   579 NIH SR Health Questionnaire 9-26-12 ,   586 NASA Questonnaire final 8.27.12 ,   587 NFPA NFCSS questionnaire ,   588 PBGC-PBGC.gov v4 10-4-12 ,   589 CDC SM Posting Survey ,   565 Investor.gov Questionnaire 10.10.12 ,   582 USGS v3 10_10_2012 ,   583 CQs for OMB started 9-5-2012 ,   584 ED.gov Questionnaire 9.6.12 ,   585 GSA V6 Survey - New Version
488 USGS Gap Analysis - 515 SSA Electronic Access	493 US Treasury, 496 Disability, 497 MakingHome, 498 NHLBI, 502 Plain Language, 504 ABMC, 505 AHRQ, 507 CMS, 508 CQs 2-9-2012, 509 CVC , 510 CVC, 511 DOD, 512 EXIM, 491 HHS Civ Rights, 488 USGS, 489 CQs, 490 OMH, 492 CQs, 494 AHRQ, 495 CQs 12-7-2011, 499 SSA, 500 RE and S-RE, 501 US Treasury, 503 EPA, 506 CIA, 513 FTC, 514 FTC.gov, 515 SSA	497 MakingHomeAffordable.gov ,   498 NHLBI Qnaire ,   499 SSA FAQ v2 ,   500 Survey Final RE and S-RE 12.27.11 ,   501 US Treasury Questionnaire Template 1-27-2011 ,   502 Plain Language Questions ,   503 EPA v4 11-17-2011 ,   504 ABMC ,   505 AHRQ Guidelines 3-8-2012 ,   506 CIA Careers Site V2 2-28-2012 ,   507 CMS_NAS_JF Qnaire 2-23-2012 ,   488 USGS Gap Analysis ,   489 CQ 1031-2011 ,   490 OMH Questionnaire ,   491 HHS Office of Civil Rights ,   492 CQs 10-6-2011 ,   493 US Treasury Questionnaire Template 1-31-2012 ,   494 AHRQ email 1-25-12 ,   495 CQs 12-7-11 ,   496 Disability.gov V3 ,   508 CQs for OMB 2-9-2012 ,   509 CVC Gift Shop 3-8-2012 ,   510 CVC Tour 3-9-2012 ,   511 DOD_Tricare 2-23-2012 ,   512 EXIM Final Draft Questionnaire 2-13-2012 ,   513 FTC.gov Satisfaction Survey 3-2-2012 ,   514 FTC.gov Satisfaction Survey 3-12-2012 ,   515 SSA Electronic Access
2013 729 Girls Health V2 10-31-13 - 2013 739 NIA Health and Aging 11-5-13	737, 730, 734 , 735, 736, 738, 739, 729, 731, 732, 733	2013 729 Girls Health V2 10-31-13 ,   2013 730 National Park Service (NPS) Satisfaction Survey 10-31-13 ,   2013 731 NWHIC V2 10-31-13 ,   2013 732 SAMSHA Main Site 10-14-13 ,   2013 733 SAMSHA Store V2 10-14-13 ,   2013 734 DHS CIS WTUSA 11-11-13 ,   2013 735 DOD Army Benefits Center 11-11-13 ,   2013 736 IRS ACH 11-11-13 ,   2013 737 NIA Alzheimers 11-5-13 ,   2013 738 NIA Go4Life 11-5-13 ,   2013 739 NIA Health and Aging 11-5-13
2014 892 APHIS Biotechnology Regulatory Services Survey - 2014 893 NOAA Fisheries Satisfaction Survey	892, 893	2014 892 APHIS Biotechnology Regulatory Services Survey ,   2014 893 NOAA Fisheries Satisfaction Survey
2014 810 AHRQ Email - 2014 818 MyCareeratVA	817, 810, 811, 812, 814, 815, 816, 813, 818	810 AHRQ Mail ,   811 AHRQ Enterprise ,   2014 812 DoD DMA ENT ,   2014 813 Grants.gov ,   2014 814 NIH NICHD ,   2014 815 SBA ,   2014 816 USPSTF ,   2014 817 AIDSinfoMobile ,   2014 818 MyCareeratVA
2014 781 Architect of the U.S. Capitol Gift Shop - 2014 793 FTC Compliant Assistant Survey	781, 782, 783, 784, 785, 786, 787, 788, 789, 790, 791, 792, 793	2014 783 DOT FHWA Renewal ,   2014 784 GSA Reginfo ,   2014 HRSA Renewal ,   2014 786 NHTSA Renewal ,   2014 787 NIDCR Site Feedback ,   2014 788 NIH - NCCAM ,   2014 789 NIH AIDSinfo ,   2014 790 NIH Main ,   2014 791 NIST ,   2014 792 PBGC CSAT ,   2014 793 Compliant Assistanct Survey ,   2014 781 Architect of the US Capitol Gift Shop ,   2014 782 Architect of the US Capitol Tour
2014 882 CMS Medicare - 2014 891 Treasury Direct v2	882, 883, 884, 885, 886, 887, 888, 889, 890, 891	2041 882 CMS Medicare ,   2014 883 DHS CIS Citizenship Resource Center ,   2014 884 DoD Tricard ,   2014 885 HHS OCR ,   2014 886 Maritime Administration ,   2014 887 NRC ,   2014 888 Recreation.gov ,   2014 889 Go4Life Mobile ,   2014 890 NHLBI ,   2014 891 TreasuryDirect v2
2014 748 DOC ITA Export gov - 2014 753 USPTO	748, 749, 750, 751, 752, 753	2014 748 DOC ITA Export gov ,   2014 749 EPA Regulations gov ,   2014 750 FBI Renewal ,   2014 751 GSA (OCM) Renewal ,   2014 752 U.S. Department of Education ,   2014 753 USPTO

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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	4,125,000	1,520,000	0	2,605,000	0	0
Annual Time Burden (Hours)	171,875	62,917	0	108,958	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: The Requested amount is the increase in estimated Number of Responses as well as the associated increase in estimated Total Time Burden (Hr) which is due to this request for renewal of our Generic ICR for another three years. These totals take into account the Generic IC included with the renewal request.

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Annual Cost to Federal Government: $4,629,649

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: 11/21/2011

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