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

Forms and Documents

Document Name	Status
Form PC-2142 Office of Medical Services Medical Clearance Process Customer Satisfaction Survey Form	New
Form Omnibus Survey 1 Omnibus Survey Form	New
Form PC-2042- C World Wide Schools Teacher Surveys Form and Instruction	New
Peace Corps Generic Clearance Fast Track- Supporting Statement A- Final.docx Supporting Statement A	2014-07-29
Generic Clearance Submission Template.docx Supplementary Document	2014-07-29
Peace Corps Generic Clearance Fast Track- Supporting Statement B.docx Supporting Statement B	2014-07-29

IC Document Collections

IC ID	Document Title	Status
213943	Office of Medical Services Medical Clearance Process Customer Satisfaction Survey Form	New
213699	Focus Groups with Parents of Millennials Other-Guide	New
213497	Online Bulletin Boards with Millenials Other-Sceener for Online Bulletin Board	New
212522	Omnibus Survey Form	New
212521	World Wide Schools Teacher Surveys Form and Instruction	New

ICR Details

OMB Control No: 0420-0545	ICR Reference No: 201407-0420-005
Status: Historical Active	Previous ICR Reference No: 201105-0420-002
Agency/Subagency: PEACE	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/15/2014
	Date Received in OIRA: 07/29/2014
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.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2017	36 Months From Approved	09/30/2014
Responses	31,725	0	24,678
Time Burden (Hours)	19,164	0	15,117
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): EO: EO 12862 Name/Subject of EO: 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:
	79 FR 20926	04/14/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 35580	06/23/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Omnibus Survey	Omnibus Survey 1	Omnibus Survey Questions
Office of Medical Services Medical Clearance Process Customer Satisfaction Survey	PC-2142	OHS Medical Clearance Process Customer Survey
World Wide Schools Teacher Surveys	PC-2042-A, PC-2042-B, PC-2042- C	Survey Questions for Speakers Match ,   Survey Questions for Correspondence Match ,   Survey Questions for eNewsletters
Online Bulletin Boards with Millenials
Focus Groups with Parents of Millennials

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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	31,725	24,678	0	7,047	0	0
Annual Time Burden (Hours)	19,164	15,117	0	4,047	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: Changes to number of responses and burden time reflects additional collections that the agency will be conducting that will increase the number of respondents by 2,349 per year and burden hours by 1, 349.

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Annual Cost to Federal Government: $2,336

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: 07/29/2014

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