Generic Clearance Form-Feedback Widget

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 1910-5160)

T ITLE OF INFORMATION COLLECTION:

Feedback Widget for DOE Websites (Alternative Fuels Data Center and SEE Action)

PURPOSE:

The U.S. Department of Energy Office of Energy Efficiency and Renewable Energy (EERE)’s Clean Cities Program and SEE Action programs request OMB approval for the use of a voluntary, one-question feedback widget. The feedback widget enables us to:

• gauge if user needs are being met by the web content and tools

• gauge the impact and usefulness of the information and tools

• make changes necessary to meet user needs.

The widget is placed strategically on end point pages on the Alternative Fuels Data Center (AFDC) website. The widget will be placed on an average of 10 to 20 pages at a time.

For SEE Action, the widget is placed strategically on end point pages on the SEE Action website. The widget will be placed on an average of five pages at a time.

Collection of responses: The survey will be administered using a feedback widget that asks “Did you find what you are looking for?” Participation is completely voluntary.

Data collected will be for internal use only and will not be publically shared.

Burden to public: The survey would take each respondent no more than 15 seconds to answer.

For the AFDC website, we would continue using the feedback widget until we reach 10,000 total responses.

For SEE Action website, we would continue using the feedback widget on the SEE Action website until we reach 5,000 total responses.

DESCRIPTION OF RESPONDENTS:

The survey respondents will consist of users of the Alternative Fuels Data Center website.

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.

DOE Clean Cities Director

DOE SEE Action Director

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

3. If Yes, has an up-to-date System of Records Notice (SORN) 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

AFDC

Category of Respondent	No. of Respondents*	Participation Time/Respondent	Burden
Private Sector	8,000	15 sec	33 hours
State, local, and tribal governments	2,000	15 sec	8 hours

SEE Action

Category of Respondent	No. of Respondents*	Participation Time/Respondent	Burden
State, local, and tribal governments	4000	15 sec	16 hours
Private Sector	1000	15 sec	4 hours

* We will discontinue use of the feedback widget and reapply for OMB approval after we reach 10,000 respondents for the AFDC and after 4000 for SEE Action.

FEDERAL COST: The total estimated cost to the government is less than $1,000. This includes existing staff time for evaluating the results.

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?

The feedback widget would be on end point pages of the AFDC website and would be sampling any user of this website.

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

[ ] In-person

[ ] Mail

[ ] Other, Explain

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

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

Instructions for completing Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”

TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the subject of the request. (e.g. Comment card for soliciting feedback on xxxx)

PURPOSE: Provide a brief description of the purpose of this collection and how it will be used. If this is part of a larger study or effort, please include this in your explanation.

DESCRIPTION OF RESPONDENTS: Provide a brief description of the targeted group or groups for this collection of information. These groups must have experience with the program.

TYPE OF COLLECTION: Check one box. If you are requesting approval of other instruments under the generic, you must complete a form for each instrument.

CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.

Personally Identifiable Information: Provide answers to the questions. Note: Agencies should only collect PII to the extent necessary, and they should only retain PII for the period of time that is necessary to achieve a specific objective.

Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.

BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households; (2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be selected per row.

No. of Respondents: Provide an estimate of the Number of respondents.

Participation Time: Provide an estimate of the amount of time required for a respondent to participate (e.g. fill out a survey or participate in a focus group)

Burden: Provide the Annual burden hours: Multiply the Number of responses and the participation time and divide by 60.

FEDERAL COST: Provide an estimate of the annual cost to the Federal government.

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. Please provide a description of how you plan to identify your potential group of respondents and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.

Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.

Submit all instruments, instructions, and scripts are submitted with the request.

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