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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Evaluation of How Data Visualizations Can Improve Public Health Decisions and Actions Workshop	Form and Instruction	New	Available
VTrckS Survey	Form	New	Available
All-Awardee Conference Call Survey	Form	New	Available
Evaluation Survey	Form	New	Available
Survey	Form	New	Available
Assessment for Health Facilities	Form	New	Available
Assessment for Health Depts	Form	New	Available
Survey	Form	New	Available
Evaluation	Form	New	Available
Registration	Form	New	Available
Preparing Healthcare Workers to Work in Ebola Treatment Units (ETUs) in Africa - Follow-Up Evaluatioin	Form and Instruction	New	Available
Ebola Treatment Unit (ETU) Training Course Evaluation: Day 3	Form and Instruction	New	Available
Ebola Treatment Unit (ETU) Training Course Evaluation: Day 1	Form and Instruction	New	Available
Ebola Treatment Unit (ETU) Training Course Evaluation: Day 2	Form and Instruction	New	Available
Influenza Capacities and Ebola Response Efforts - Survey	Form and Instruction	New	Available
Survey	Form	New	Available
Day 3 CDC Ebola Treatment Unit (ETU) Training Course Evaluation	Form and Instruction	New	Available
Day 2 CDC Ebola Treatment Unit (ETU) Training Course Evaluation	Form and Instruction	New	Available
Day 1 CDC Ebola Treatment Unit (ETU) Training Course Evaluation	Form and Instruction	New	Available
Generic Clearance for Qualitative Feedback Template Approval Form.docx	Supplementary Document	Uploaded 2014-07-02	Available
Service Delivery 60-Day FRN - Published - 30 April 2014.pdf	Supplementary Document	Uploaded 2014-07-02	Available
Service Delivery_Supporting_Statement_B_NCIRD.docx	Supporting Statement B	Uploaded 2014-07-02	Available
Service Delivery_Generic_Supporting_Statement_A_NCIRD.docx	Supporting Statement A	Uploaded 2014-07-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
221895	Evaluation of Workshop: How Data Visualizations Can Improve Public Health Decisions and Actions	Form and Instruction	New	Evaluation of How Data Visualizations Can Improve Public Health Decisions and Actions Workshop
219405	Flu on CallTM National Network of Telephone Triage Lines Demonstration Pilot	Instruction	New
218726	VTrckS Contact Center Customer Satisfaction Survey 2015	Form	New	VTrckS Survey
218152	ISD All-Awardee Conference Call Survey	Form	New	All-Awardee Conference Call Survey
218144	AFIX Quarterly Call Evaluation	Other-Screenshots	New
217790	CDC Influenza Partner Activity Web Page Evaluation	Other-WORD	New
217768	2015 Immunization Awardee Meeting Evaluation	Form	New	Evaluation Survey
217291	Chronic Fatigue Syndrome: Symptoms from the Patient Perspective	Other-WORD	New
217154	HPV Vaccination Quarterly Reports Satisfaction Survey	Form	New	Survey
215587	Management of Fever in Travelers from Ebola Affected and Ebola Non-affected Malaria Endemic Countries	Form	New	Assessment for Health Facilities
215587	Management of Fever in Travelers from Ebola Affected and Ebola Non-affected Malaria Endemic Countries	Form	New	Assessment for Health Depts
214764	Children's Hospital Collaboration Forum Customer Satisfaction Survey	Form	New	Survey
214582	Preparing Healthcare Workers to Work in Ebola Treatment Units (ETUs) in Africa: Training Toolkit_Registration and Evaluation	Form	New	Evaluation
214582	Preparing Healthcare Workers to Work in Ebola Treatment Units (ETUs) in Africa: Training Toolkit_Registration and Evaluation	Form	New	Registration
214491	Follow-Up Ebola Treatment Unit (ETU) Training Course Evaluation	Form and Instruction	New	Preparing Healthcare Workers to Work in Ebola Treatment Units (ETUs) in Africa - Follow-Up Evaluatioin
214487	Key Informant Interviews for Emergency Risk Communication Improvement during the Ebola Response	Other-Interview Guide	New
214384	Web-based Ebola Treatment Unit (ETU) Training Course Evaluation	Form and Instruction	New	Ebola Treatment Unit (ETU) Training Course Evaluation: Day 3
214384	Web-based Ebola Treatment Unit (ETU) Training Course Evaluation	Form and Instruction	New	Ebola Treatment Unit (ETU) Training Course Evaluation: Day 1
214384	Web-based Ebola Treatment Unit (ETU) Training Course Evaluation	Form and Instruction	New	Ebola Treatment Unit (ETU) Training Course Evaluation: Day 2
213801	Influenza Capacity Platforms during Ebola Response Efforts in Africa	Form and Instruction	New	Influenza Capacities and Ebola Response Efforts - Survey
213799	Feedback to Consumer Access to Immunization Information System (IIS)	Form	New	Survey
213465	CDC Ebola Treatment Unit Training Course Evaluation	Form and Instruction	New	Day 3 CDC Ebola Treatment Unit (ETU) Training Course Evaluation
213465	CDC Ebola Treatment Unit Training Course Evaluation	Form and Instruction	New	Day 2 CDC Ebola Treatment Unit (ETU) Training Course Evaluation
213465	CDC Ebola Treatment Unit Training Course Evaluation	Form and Instruction	New	Day 1 CDC Ebola Treatment Unit (ETU) Training Course Evaluation
212676	Assessment Branch (AB) Partner Data Assessment Project	Other-WORD	New
212674	VTrckS Awardee Survey/Partner Data Assessment Project	Other-PDF	New

ICR Details

OMB Control No: 0920-1026	ICR Reference No: 201407-0920-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-14UQ
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCIRD)
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: 07/25/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/14/2014
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.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	36 Months From Approved
Responses	9,900	0	0
Time Burden (Hours)	6,588	0	0
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: 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:
	79 FR 24432	04/30/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 39400	07/10/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 20

table that charts list of burden

IC Title	Form No.	Form Name
2015 Immunization Awardee Meeting Evaluation	none	Evaluation Survey
AFIX Quarterly Call Evaluation
Assessment Branch (AB) Partner Data Assessment Project
CDC Ebola Treatment Unit Training Course Evaluation	None, None, None	Day 1 CDC Ebola Treatment Unit (ETU) Training Course Evaluation ,   Day 2 CDC Ebola Treatment Unit (ETU) Training Course Evaluation ,   Day 3 CDC Ebola Treatment Unit (ETU) Training Course Evaluation
CDC Influenza Partner Activity Web Page Evaluation
Children's Hospital Collaboration Forum Customer Satisfaction Survey	none	Survey
Chronic Fatigue Syndrome: Symptoms from the Patient Perspective
Evaluation of Workshop: How Data Visualizations Can Improve Public Health Decisions and Actions	NA	Evaluation of How Data Visualizations Can Improve Public Health Decisions and Actions Workshop
Feedback to Consumer Access to Immunization Information System (IIS)	none	Survey
Flu on CallTM National Network of Telephone Triage Lines Demonstration Pilot
Follow-Up Ebola Treatment Unit (ETU) Training Course Evaluation	None	Preparing Healthcare Workers to Work in Ebola Treatment Units (ETUs) in Africa - Follow-Up Evaluatioin
HPV Vaccination Quarterly Reports Satisfaction Survey	none	Survey
ISD All-Awardee Conference Call Survey	none	All-Awardee Conference Call Survey
Influenza Capacity Platforms during Ebola Response Efforts in Africa	None	Influenza Capacities and Ebola Response Efforts - Survey
Key Informant Interviews for Emergency Risk Communication Improvement during the Ebola Response
Management of Fever in Travelers from Ebola Affected and Ebola Non-affected Malaria Endemic Countries	none, none	Assessment for Health Depts ,   Assessment for Health Facilities
Preparing Healthcare Workers to Work in Ebola Treatment Units (ETUs) in Africa: Training Toolkit_Registration and Evaluation	none, none	Registration ,   Evaluation
VTrckS Awardee Survey/Partner Data Assessment Project
VTrckS Contact Center Customer Satisfaction Survey 2015	none	VTrckS Survey
Web-based Ebola Treatment Unit (ETU) Training Course Evaluation	None, None, None	Ebola Treatment Unit (ETU) Training Course Evaluation: Day 1 ,   Ebola Treatment Unit (ETU) Training Course Evaluation: Day 2 ,   Ebola Treatment Unit (ETU) Training Course Evaluation: Day 3

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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	9,900	0	0	9,900	0	0
Annual Time Burden (Hours)	6,588	0	0	6,588	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 new Service Delivery Generic Request.

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Annual Cost to Federal Government: $60,000

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 07/14/2014

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