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

Forms and Documents

Document Name	Status
Evaluation of Workshop: How Data Visualizations Can Improve Public Health Decisions and Actions Form and Instruction	New
VTrckS Contact Center Customer Satisfaction Survey 2015 Form	New
ISD All-Awardee Conference Call Survey Form	New
2015 Immunization Awardee Meeting Evaluation Form	New
HPV Vaccination Quarterly Reports Satisfaction Survey Form	New
Management of Fever in Travelers from Ebola Affected and Ebola Non-affected Malaria Endemic Countries Form	New
Children's Hospital Collaboration Forum Customer Satisfaction Survey Form	New
Preparing Healthcare Workers to Work in Ebola Treatment Units (ETUs) in Africa: Training Toolkit_Registration and Evaluation Form	New
Follow-Up Ebola Treatment Unit (ETU) Training Course Evaluation Form and Instruction	New
Web-based Ebola Treatment Unit (ETU) Training Course Evaluation Form and Instruction	New
Influenza Capacity Platforms during Ebola Response Efforts in Africa Form and Instruction	New
Feedback to Consumer Access to Immunization Information System (IIS) Form	New
CDC Ebola Treatment Unit Training Course Evaluation Form and Instruction	New
Generic Clearance for Qualitative Feedback Template Approval Form.docx Supplementary Document	2014-07-02
Service Delivery 60-Day FRN - Published - 30 April 2014.pdf Supplementary Document	2014-07-02
Service Delivery_Supporting_Statement_B_NCIRD.docx Supporting Statement B	2014-07-02
Service Delivery_Generic_Supporting_Statement_A_NCIRD.docx Supporting Statement A	2014-07-02

IC Document Collections

IC ID	Document Title	Status
221895	Evaluation of Workshop: How Data Visualizations Can Improve Public Health Decisions and Actions Form and Instruction	New
219405	Flu on CallTM National Network of Telephone Triage Lines Demonstration Pilot Instruction	New
218726	VTrckS Contact Center Customer Satisfaction Survey 2015 Form	New
218152	ISD All-Awardee Conference Call Survey Form	New
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
217291	Chronic Fatigue Syndrome: Symptoms from the Patient Perspective Other-WORD	New
217154	HPV Vaccination Quarterly Reports Satisfaction Survey Form	New
215587	Management of Fever in Travelers from Ebola Affected and Ebola Non-affected Malaria Endemic Countries Form	New
214764	Children's Hospital Collaboration Forum Customer Satisfaction Survey Form	New
214582	Preparing Healthcare Workers to Work in Ebola Treatment Units (ETUs) in Africa: Training Toolkit_Registration and Evaluation Form	New
214491	Follow-Up Ebola Treatment Unit (ETU) Training Course Evaluation Form and Instruction	New
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
213801	Influenza Capacity Platforms during Ebola Response Efforts in Africa Form and Instruction	New
213799	Feedback to Consumer Access to Immunization Information System (IIS) Form	New
213465	CDC Ebola Treatment Unit Training Course Evaluation Form and Instruction	New
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
	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.

	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

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

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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	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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