Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Forms and Documents

Document Name	Status
VetoViolence Usability Testing Form	New
Assessing "Return to Learn" Programs Form	New
Stopping Elderly Accidents, Deaths, and Injuries (STEADI) - Focus Groups Form and Instruction	New
Form 0920-1009 Assessing the Effectiveness of HEADS UP Message Form and Instruction	New
Customer Service - HEADS UP Rocket Blades Form and Instruction	New
Form 0920-1009 Youth Violence Training and Technical Assistance Satisfaction Survey Form and Instruction	New
Form 0920-1009 Division of Violence Prevention grantee individual interviews regarding VetoViolence.cdc.gov Form and Instruction	New
VetoViolence Online Survey Form	New
Injury Website Online Survey – Second request Form	New
Customer Feedback of state-level traumatic brain injury prevention workers Form and Instruction	New
Injury Website Online Survey Form	New
WISQARS Discussion Groups Form	Unchanged
Change Request.docx Justification for No Material/Nonsubstantive Change	2014-05-01
Supporting Statement B.docx Supporting Statement B	2014-01-27
Fast_Track_GenIC_RequestTemplate - BLANK.docx Supplementary Document	2014-01-27
Supporting Statement A.docx Supporting Statement A	2014-01-27

IC Document Collections

IC ID	Document Title	Status
224152	GenIC "Primary Care Provider - Stopping Elderly Accidents, Deaths, and Injuries (STEADI)" Other-WORD	New
222774	GenIC Division of Violoence Prevention Webinar Participant Feedback Other-WORD	New
221710	VetoViolence Usability Testing Form	New
221572	Assessing "Return to Learn" Programs Form	New
221538	Stopping Elderly Accidents, Deaths, and Injuries (STEADI) - Focus Groups Form and Instruction	New
221119	Assessing the Effectiveness of HEADS UP Message Form and Instruction	New
220790	Customer Service - HEADS UP Rocket Blades Form and Instruction	New
220543	Customer feedback interviews with state-level implementers of "Return to Learn" Other-WORD	New
219607	Youth Violence Training and Technical Assistance Satisfaction Survey Form and Instruction	New
219366	Division of Violence Prevention grantee individual interviews regarding VetoViolence.cdc.gov Form and Instruction	New
215501	VetoViolence Online Survey Form	New
213980	Injury Website Online Survey – Second request Form	New
213822	Customer Feedback of state-level traumatic brain injury prevention workers Form and Instruction	New
213602	Injury Website Online Survey Form	New
212036	WISQARS Home Page Survey Other-WORD	New
211588	WISQARS Mobile App Online Survey Other-WORD	New
211297	Customer Satisfaction (User Feedback) of a Mobile Application to Improve Preparation and Response to a Terrorist Event or Other Mass Casualty Event Other-WORD	Unchanged
211074	WISQARS Discussion Groups Form	Unchanged

ICR Details

OMB Control No: 0920-1009	ICR Reference No: 201405-0920-002
Status: Historical Active	Previous ICR Reference No: 201401-0920-008
Agency/Subagency: HHS/CDC	Agency Tracking No: 21359
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/07/2014
	Date Received in OIRA: 05/05/2014
Terms of Clearance: Previous Terms continue: 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.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	03/31/2017	03/31/2017
Responses	228,000	0	180,000
Time Burden (Hours)	104,250	0	56,250
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 stateholder feedback in an efficient, timely manner, in accordance with our commitment to improving service elivery. The informaiton 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	12/22/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 4909	01/30/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 18

IC Title	Form No.	Form Name
WISQARS Mobile App Online Survey
Customer Feedback of state-level traumatic brain injury prevention workers	none	TBI Small Group Discussion Protocol
Customer feedback interviews with state-level implementers of "Return to Learn"
Assessing "Return to Learn" Programs	none	Return to Learn Assessment
VetoViolence Online Survey	none	VetoViolence Survey
Division of Violence Prevention grantee individual interviews regarding VetoViolence.cdc.gov	0920-1009	Instrument - VetoViolAss
GenIC "Primary Care Provider - Stopping Elderly Accidents, Deaths, and Injuries (STEADI)"
WISQARS Discussion Groups	none	Discussion Guide
Customer Service - HEADS UP Rocket Blades	NA, NA	Child Survey - HEADS UP_Rocket Blades ,   Parent Survey - HEADS UP_Rocket Blades
GenIC Division of Violoence Prevention Webinar Participant Feedback
Youth Violence Training and Technical Assistance Satisfaction Survey	0920-1009	0920-1009 16JS Youth Violence Training
Stopping Elderly Accidents, Deaths, and Injuries (STEADI) - Focus Groups	NA, NA, NA	Recruitment Screening Phone Script ,   STEADI Focus Group Moderator Guide 18MAY2016 ,   STEADI Phone Interview Moderator Guide 18MAY2016
Injury Website Online Survey	None	Injury Web Survey
VetoViolence Usability Testing	none	Survey
Customer Satisfaction (User Feedback) of a Mobile Application to Improve Preparation and Response to a Terrorist Event or Other Mass Casualty Event
Assessing the Effectiveness of HEADS UP Message	0920-1009, 0920-1009	Attachment A_Screener ,   Attachment B_Instrument
WISQARS Home Page Survey
Injury Website Online Survey – Second request	none	Website Survey

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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	228,000	180,000	0	48,000	0	0
Annual Time Burden (Hours)	104,250	56,250	0	48,000	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: Program underestimated the types and number of service delivery feedback projects they expect to do.

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Annual Cost to Federal Government: $60,000

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: 05/05/2014

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