Supporting Statement

Request for Approval under the “Generic Clearance for the Collection of
Routine Customer Feedback” (OMB Control Number: 1545-2208)
TITLE OF INFORMATION COLLECTION: Electronic Funds Research – Questions in
Forrester’s Online Omnibus research
PURPOSE: IRS seeks information on taxpayers’ preferences in the method of receiving their
federal tax refund.
DESCRIPTION OF RESPONDENTS: Potential respondents are selected from a panel of
individuals based on demographic characteristics (such as gender, age, location) and are
contacted by email. Vendor (Forrester) keeps PII on panel members including name, address,
phone number, and email address to contact individuals to participate in various surveys.
TYPE OF COLLECTION: (Check one)
[ ] Customer Comment Card/Complaint Form
[ ] Usability Testing (e.g., Website or Software
[ ] Focus Group

[X] Customer Satisfaction Survey
[ ] Small Discussion 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.

QHRFB
Name: __________Jim O’Donnell (202)-803-9008___________________________

Digitally signed by QHRFB
DN: cn=QHRFB, [email protected]
Date: 2014.05.14 09:23:35 -04'00'

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”, will any information that is collected be included in records that are subject to the
Privacy Act of 1974? [ ] Yes [ ] No
3. If “Yes”, has an up-to-date System of Records Notice (SORN) 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

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BURDEN HOURS
Category of Respondent

No. of
Respondents
5000

Participation
Time (minutes)
5

Burden
417 hrs

Totals
FEDERAL COST: The estimated annual cost to the Federal government is $_7536.00____.
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?
[ ] Yes [ X ] 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?
Potential respondents are selected from a panel of individuals based on demographic
characteristics (such as gender, age, location) and are contacted by email. Vendor (Forrester)
keeps PII on panel members including name, address, phone number, and email address to
contact individuals to participate in various surveys.
Administration of the Instrument
1. How will you collect the information? (Check all that apply)
[X] Web-based or other forms of Social Media
[ ] Telephone
[ ] In-person
[ ] Mail
[ ] Other, Explain
2. Will interviewers or facilitators be used? [ ] Yes [X] No
Please make sure that all instruments, instructions, and scripts are submitted with the
request.

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