Request for Approval under the Generic Clearance for the Collection of Routine Customer Feedback

TAD - Generic Survey Template.doc

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

Request for Approval under the Generic Clearance for the Collection of Routine Customer Feedback

OMB: 2120-0746

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Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 2120-0746)

T ITLE OF INFORMATION COLLECTION:


PURPOSE:


The data collected will be analyzed by the Transport Airplane Directorate management team to determine the quality of services provided to industry and government applicants. This survey activity supports the Department of Transportation strategic goal for a “Customer Service Management Strategy,” which is to “deliver the results customers want through a government that works better, is more practical, and costs less.”




DESCRIPTION OF RESPONDENTS:


The respondents are certification project applicants. These include applicants for Type Certificates, Amended Type Certificates, Supplemental Type Certificates and Parts Manufacturing Approvals.




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.


Name:__Ed Mills ______________________________________________


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

  3. If Applicable, has a System or Records Notice 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


Category of Respondent

No. of Respondents

Participation Time

Burden

Certification project applicants

480

15 min.

120 hrs.





Totals

480

15 min.

120 hrs.



FEDERAL COST: The estimated annual cost to the Federal government is $18050 annually for administrative staff preparation and analysis of surveys.


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 respondent universe includes any certification project applicant who is issued a certificate; the survey is mailed out in hard copy format to all certification project applicants along with their certificate when it is issued.




Administration of the Instrument

  1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[X] Mail

[ ] Other, Explain

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

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


File Typeapplication/msword
File TitleRequest for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 2120-074
AuthorTaylor CTR Dahl
Last Modified ByTaylor CTR Dahl
File Modified2012-02-06
File Created2012-02-06

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