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
Don't Mess with Mercury Webinar Survey	Form	New	Available
Group discussion guide	Form and Instruction	New	Available
Form 0923-0047 AttB ATSDR Customer Satisfaction Survey Questionnaire	Form and Instruction	New	Available
Form 0923-0047 AttA Script for ATSDR Customer Satisfaction Survey	Form and Instruction	New	Available
Sample Card Sort Screen Shots	Form	New	Available
ATSDR Customer Satisfaction Survey for DCHI Documents (on-line)	Form	New	Available
ATSDR Customer Satisfaction Survey for DCHI Documents (on-line)	Form	New	Available
Fast_Track_Generic_Clearance_Supporting_Statement_B_ATSDR 20130502.docx	Supporting Statement B	Uploaded 2013-05-02	Available
ATSDR Draft Generic Clearance for Qualitative Feedback Template Approval Form.docx	Supplementary Document	Uploaded 2013-05-02	Available
Fast_Track_Generic_Clearance_Supporting_Statement_A_ATSDR 20130502.docx	Supporting Statement A	Uploaded 2013-05-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
217925	ATSDR "Don't Mess with Mercury" Webinar Survey	Form	New	Don't Mess with Mercury Webinar Survey
217063	Participant Feedback at ATSDR-organized conference session	Form and Instruction	New	Group discussion guide
216365	ATSDR Safe Child Care Siting Survey	Other-WORD	New
216345	Radiation Dose Tool Feedback	Other-Telephone Screener	New
215833	Radiation Dose Tool Feedback	Other-WORD	New
214299	ATSDR Customer Satisfaction Survey	Form and Instruction	New	AttB ATSDR Customer Satisfaction Survey Questionnaire
214299	ATSDR Customer Satisfaction Survey	Form and Instruction	New	AttA Script for ATSDR Customer Satisfaction Survey
211029	Card Sorting Study	Form	New	Sample Card Sort Screen Shots
208586	ATSDR Customer Satisfaction Survey for DCHI Documents	Form	New	ATSDR Customer Satisfaction Survey for DCHI Documents (on-line)
208586	ATSDR Customer Satisfaction Survey for DCHI Documents	Form	New	ATSDR Customer Satisfaction Survey for DCHI Documents (on-line)

ICR Details

OMB Control No: 0923-0047	ICR Reference No: 201305-0923-003
Status: Historical Active	Previous ICR Reference No: 201302-0923-001
Agency/Subagency: HHS/TSDR	Agency Tracking No: 19457
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 without change	Conclusion Date: 05/16/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/08/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2016	36 Months From Approved
Responses	8,400	0	0
Time Burden (Hours)	7,275	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The 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): 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	12/20/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 70780	11/27/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
ATSDR "Don't Mess with Mercury" Webinar Survey	none	Don't Mess with Mercury Webinar Survey
ATSDR Customer Satisfaction Survey	0923-0047, 0923-0047	AttA Script for ATSDR Customer Satisfaction Survey ,   AttB ATSDR Customer Satisfaction Survey Questionnaire
ATSDR Customer Satisfaction Survey for DCHI Documents	None, None	ATSDR Customer Satisfaction Survey for DCHI Documents (on-line) ,   ATSDR Customer Satisfaction Survey for DCHI Documents (on-line)
ATSDR Safe Child Care Siting Survey
Card Sorting Study	none	Sample Card Sort Screen Shots
Participant Feedback at ATSDR-organized conference session	none	Group discussion guide
Radiation Dose Tool Feedback
Radiation Dose Tool Feedback

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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	8,400	0	0	8,400	0	0
Annual Time Burden (Hours)	7,275	0	0	7,275	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 resubmission of a request for a generic clearance under the fast track mechanism.

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Annual Cost to Federal Government: $500,000

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: 05/08/2013

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