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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 AmeriCorps State and National Symposium Evaluation Instrument	Form and Instruction	New	Available
Form 1 Core Curriculum Pre and Post Tests	Form and Instruction	New	Available
Form 1 Senior Corps Focus Group Questions and Survey	Form and Instruction	New	Available
Form 1 VISTA PSO Feedback Survey	Form and Instruction	New	Available
Form 1 Feedback Form 2015 Research Summit	Form	New	Available
Form 1 Operation AmeriCorps Feedback Interview	Form and Instruction	New	Available
Form 1 SIF Customer Service Survey Instrument	Form and Instruction	New	Available
Generic Clearance Submission Template.docx	Supplementary Document	Uploaded 2011-04-20	Available
Generic for Feedback Clearance Template Part B 2.10.15.doc	Supporting Statement B	Uploaded 2015-03-09	Available
Generic for Feedback Clearance Template Part A 2.10.15.docx	Supporting Statement A	Uploaded 2015-03-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
227445	AmeriCorps State and National Symposium Evaluation	Form and Instruction	New	AmeriCorps State and National Symposium Evaluation Instrument
226908	Pre- and Post-test for Knowledge Management System	Form and Instruction	New	Core Curriculum Pre and Post Tests
224548	Senior Corps Focus Groups	Form and Instruction	New	Senior Corps Focus Group Questions and Survey
219470	VISTA PSO Feedback	Form and Instruction	New	VISTA PSO Feedback Survey
219367	Feedback on 2015 Research Summit	Form	New	Feedback Form 2015 Research Summit
217879	Feedback on Operation AmeriCorps Processes	Form and Instruction	New	Operation AmeriCorps Feedback Interview
216602	Social Innovation Fund Customer Service Survey	Form and Instruction	New	SIF Customer Service Survey Instrument

ICR Details

OMB Control No: 3045-0137	ICR Reference No: 201503-3045-001
Status: Historical Active	Previous ICR Reference No: 201406-3045-005
Agency/Subagency: CNCS	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/06/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/09/2015
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	05/31/2018	36 Months From Approved	08/31/2017
Responses	10,000	0	2,000
Time Burden (Hours)	1,667	0	500
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable CNCS 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): US Code: 44 USC 3501 et.seq. Name of Law: Paperwork Reduction Act
  

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 74096	12/15/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 12157	03/06/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
AmeriCorps State and National Symposium Evaluation	1	AmeriCorps State and National Symposium Evaluation Instrument
Feedback on 2015 Research Summit	1	Feedback Form 2015 Research Summit
Feedback on Operation AmeriCorps Processes	1	Operation AmeriCorps Feedback Interview
Pre- and Post-test for Knowledge Management System	1	Core Curriculum Pre and Post Tests
Senior Corps Focus Groups	1	Senior Corps Focus Group Questions and Survey
Social Innovation Fund Customer Service Survey	1	SIF Customer Service Survey Instrument
VISTA PSO Feedback	1	VISTA PSO Feedback Survey

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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	10,000	2,000	0	8,000	0	0
Annual Time Burden (Hours)	1,667	500	0	1,167	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: The burden has increased due to demand to use this collection.

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Annual Cost to Federal Government: $0

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: 03/09/2015

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