Short Form

Request for Approval under the “Generic Clearance for the Collection of Routine
Customer Feedback” (OMB Control Number: 1545-2256)

TITLE OF THE STUDY: Responsive Payments Formative Usability Study
PURPOSE:
The purpose of the data that will be collected in this study is to evaluate a series of prototype IRS.gov
webpages that have been responsively designed as compared to the exact live version IRS.gov webpages
that are not responsively designed. The objective of the study is to assess product design choices and
allow potential users the opportunity to provide comments and feedback that can be used in the new
iteration of the application.
DESCRIPTION OF RESPONDENTS:
The respondents will consist of individual taxpayers who have experience using iOS and/or Android
based mobile and/or tablet devices.
TYPE OF COLLECTION: (Check one)
[ ] Customer Comment Card/Complaint Form
[ x ] Usability Testing (e.g., Website or Software
[ ] Focus Group

[ ] Customer Satisfaction Survey
[ ] Small Discussion 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.
Name: _Andrew Hughey_([email protected])_________
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? [ x ] Yes [ ] No
Each participant will be provided with an incentive for participating in the usability study. Incentives
encourage participation, and are used to cover the cost of participants taking time away from work and
their daily lives to participate in the study. Participants for in-person usability testing will each be
provided a $40.00 incentive. This incentive helps to cover the cost of parking, transportation, childcare,
and other costs.
BURDEN HOURS:
Category of Respondent

No. of
Respondents

Participation
Time

Burden

Individuals (participation in study)

16

30 minutes

8 hrs

Individuals (study recruitment)

40

5 minutes

3.3 hrs

Totals

56

11.3 hrs

FEDERAL COST:
Category of Cost

Cost

Participant Incentives (16 participants X $40/participant)

$640

Study Recruitment, Facilitation, and Data Analysis

$5,200

Totals Annual Cost to the Federal Government

$5,840

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?
[ x ] Yes
[ ] 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 company performing the recruiting and facilitation of the study has a recruitment database that
contains a list of individuals that have previously indicated having an interest in taking part in usability
studies. The database contains background information that can be used to select the appropriate
candidates to contact about participating in this study.
It is planned that a total of 16 individual taxpayers who have experience using mobile and/or tablet
devices and reside in the study test location region will be recruited to participate in the study. No
specific gender or age range will be targeted.

Administration of the Instrument
1. How will you collect the information? (Check all that apply)
[ x ] Web-based or other forms of Social Media
[ x ] Telephone
[ x ] In-person
[ ] Mail
[ ] Other, Explain
2. Will interviewers or facilitators be used? [ x ] Yes [ ] No
Please make sure that all instruments, instructions, and scripts are submitted with the request.

See the attached Responsive Payments Formative Usability Study Plan document.