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
Survey	Form	New	Available
Questionnaire	Form	New	Available
Participant Scenario List	Form	New	Available
Attachment 10: CDC Keeps America Healthy, Safe, and Secure. Case Study: Fort Leonard Wood, Missouri	Form and Instruction	New	Available
Attachment 9: CDC Priorities and FY 2014 Budget Request	Form and Instruction	New	Available
Attachment 8: The National Violent Death Reporting System (NVDRS): A Valuable Tool for Prevention	Form and Instruction	New	Available
Attachment 7: Use the Model Aquatic Health Code to Make Swimming Healthy and Safe	Form and Instruction	New	Available
Attachment 6: Heart Disease Facts	Form and Instruction	New	Available
Attachment 5: HAI Summary Data Reports: Questions and Answers	Form and Instruction	New	Available
Attachment 4: Autism and Developmental Disabilities Monitoring Network (ADDM) Tracking Autism in Wisconsin: What You Need to Know	Form and Instruction	New	Available
Attachment 3: Flu Vaccine Information for Health Care Workers	Form and Instruction	New	Available
Attachment 2: Click Testing Screen Shots	Form and Instruction	New	Available
CDC Homepage Mobile and Desktop	Form	New	Available
CDC Homepage Mobile & Desktop Survey	Form	New	Available
Survey	Form	New	Available
Vital Signs Survey	Form and Instruction	New	Available
Vital Signs Survey	Form and Instruction	New	Available
Generic_Clearance_Submission_Template[1].doc	Supplementary Document	Uploaded 2013-03-20	Available
Sup Sta B.docx	Supporting Statement B	Uploaded 2013-03-18	Available
30dy1313KL.docx	Supplementary Document	Uploaded 2013-03-18	Available
Sup Sta A.docx	Supporting Statement A	Uploaded 2013-03-18	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210376	Testing Clear Communication Index Website	Form	New	Survey
210038	Solve the Outbreak (14GM)	Other-Screenshots	New
210038	Solve the Outbreak (14GM)	Form	New	Questionnaire
209701	CDC Homepage UX	Form	New	Participant Scenario List
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index	Form and Instruction	New	Attachment 10: CDC Keeps America Healthy, Safe, and Secure. Case Study: Fort Leonard Wood, Missouri
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index	Form and Instruction	New	Attachment 9: CDC Priorities and FY 2014 Budget Request
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index	Form and Instruction	New	Attachment 8: The National Violent Death Reporting System (NVDRS): A Valuable Tool for Prevention
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index	Form and Instruction	New	Attachment 7: Use the Model Aquatic Health Code to Make Swimming Healthy and Safe
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index	Form and Instruction	New	Attachment 6: Heart Disease Facts
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index	Form and Instruction	New	Attachment 5: HAI Summary Data Reports: Questions and Answers
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index	Form and Instruction	New	Attachment 4: Autism and Developmental Disabilities Monitoring Network (ADDM) Tracking Autism in Wisconsin: What You Need to Know
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index	Form and Instruction	New	Attachment 3: Flu Vaccine Information for Health Care Workers
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index	Form and Instruction	New	Attachment 2: Click Testing Screen Shots
208545	CDC Homepage Mobile & Desktop Survey	Form	New	CDC Homepage Mobile and Desktop
208545	CDC Homepage Mobile & Desktop Survey	Form	New	CDC Homepage Mobile & Desktop Survey
207575	Solve the Outbreak iPad Survey	Form	New	Survey
207398	Vital Signs Survey	Form and Instruction	New	Vital Signs Survey
207398	Vital Signs Survey	Form and Instruction	New	Vital Signs Survey

ICR Details

OMB Control No: 0920-0956	ICR Reference No: 201303-0920-011
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 19161
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: 03/20/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/20/2013
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	03/31/2016	36 Months From Approved
Responses	10,250	0	0
Time Burden (Hours)	5,250	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.

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Authorizing Statute(s): US Code: 42 USC 41 Name of Law: Public Health Service Act
  

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:
	77 FR 61409	10/09/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
CDC Homepage Mobile & Desktop Survey	None, None	CDC Homepage Mobile & Desktop Survey ,   CDC Homepage Mobile and Desktop
CDC Homepage UX	none	Participant Scenario List
Solve the Outbreak (14GM)	none	Questionnaire
Solve the Outbreak iPad Survey	none	Survey
Testing Clear Communication Index Website	none	Survey
Testing of Sample Materials Developed Using the CDC Clear Communications Index	None, None, None, None, None, None, None, None, None	Attachment 2: Click Testing Screen Shots ,   Attachment 3: Flu Vaccine Information for Health Care Workers ,   Attachment 4: Autism and Developmental Disabilities Monitoring Network (ADDM) Tracking Autism in Wisconsin: What You Need to Know ,   Attachment 5: HAI Summary Data Reports: Questions and Answers ,   Attachment 6: Heart Disease Facts ,   Attachment 7: Use the Model Aquatic Health Code to Make Swimming Healthy and Safe ,   Attachment 8: The National Violent Death Reporting System (NVDRS): A Valuable Tool for Prevention ,   Attachment 9: CDC Priorities and FY 2014 Budget Request ,   Attachment 10: CDC Keeps America Healthy, Safe, and Secure. Case Study: Fort Leonard Wood, Missouri
Vital Signs Survey	None, None	Vital Signs Survey ,   Vital Signs 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	10,250	0	0	10,250	0	0
Annual Time Burden (Hours)	5,250	0	0	5,250	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 NEW Generic Clearance.

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Annual Cost to Federal Government: $36,130

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: 03/20/2013

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