Request for Approval of Service Delivery Request

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-1071)

TITLE OF INFORMATION COLLECTION:

Customer Satisfaction Survey for CDC AR Isolate Bank

PURPOSE:

The CDC AR Isolate Bank Customer Satisfaction Survey will capture feedback regarding ease of use, product quality, and expectations for future panels from AR Isolate Bank customers. This survey comes one year after the AR Isolate Bank launched. Results will provide a benchmark for measuring future use, inform new features added, and provide insight for success stories.

DESCRIPTION OF RESPONDENTS:

Respondents will be those who have received orders from the AR Isolate Bank. Respondents represent laboratorians and researchers at academic research institutions, device and drug manufacturers, hospitals and clinics, state and local health departments, and other U.S. Federal agencies.

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: Jean B. Patel, PhD, D(ABMM)

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [X] Yes [ ] No

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

3. If Applicable, has a System or Records Notice been published? [X ] Yes [ ] No

09-20-0136, “Epidemiologic Studies and Surveillance of Disease Problems”

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 Hours
Private sector	95	10 minutes	16
Totals			16

FEDERAL COST: The estimated annual cost to the Federal government is $1,000 (2 GS-12 Level 1 FTEs for 16 hours each)

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?

We will use the AR Isolate Bank order list for distribution of the survey.

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.

Instructions for completing Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”

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