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 0920-1071 CDC Laboratory Customer Satisfaction Survey - CDC NCEH NSMBB Laboratory Proficiency Testing	Form and Instruction	New	Available
Form 0923-0047 Sub-County Geocoding Standards Survey	Form and Instruction	New	Available
Post-workshop survey - screenshots	Form	New	Available
Form 0923-0047 VSP Training Seminar Customer Satisfaction Survery Att. A	Form and Instruction	New	Available
Form 0923-0047 ATSDR Choose Safe Places for Early Care and Education Survey	Form and Instruction	New	Available
Form 0923-0047 NCEH/ATSDR Wellness Needs Assessment - Federal Employees/Contractors/Fellows	Form and Instruction	New	Available
Form 0923-0047 NCEH/ATSDR Wellness Needs Assessment - Screenshot	Form and Instruction	New	Available
National Asthma Control Program Grantees Meeting Evaluation	Form and Instruction	New	Repair queued
National Asthma Control Program Grantees Meeting Evaluation	Form and Instruction	New	Available
Form 0923-0047 CDC GIS Website Content Strategy Survey	Form and Instruction	New	Available
Tobacco Laboratory - Customer Service Survey	Form and Instruction	New	Repair queued
Customer Satisfaction Survey for the CDC Newborn Screening Quality Assurance Program	Form and Instruction	New	Available
Where in the World quiz	Form	New	Available
Registration and Feedback	Form	New	Available
Form 0923-17AZF Attachment C GPHEW NA Survey Screenshots	Form	New	Available
Form 0923-17AZF Attachment B GPHEW NA Survey Text	Form and Instruction	New	Repair queued
Feedback Form and Follow-up Interview Questions	Form and Instruction	New	Repair queued
ALS Customer Satisfaction Survey - word	Form	New	Available
ALS Customer Satisfaction Survey	Form	New	Available
Form 17AIX Attachment C - APPLETREE Post Meeting Survey_text	Form and Instruction	New	Available
Form 17AIX Attachment B - APPLETREE Post Meeting Survey_screenshot	Form and Instruction	New	Available
Survey for CDC's Social Vulnerability Index (SVI) Website - Screenshot	Form and Instruction	New	Available
NCEH/ATSDR Office of Science Regulatory Team Customer Ssatisfaction Survey	Form and Instruction	New	Available
Form 17wl Attachment A - Respondent Screeners	Form and Instruction	New	Available
CSTE Feedback - Use of Geospatial Methods During Responses	Form	New	Repair queued
User Satisfaction Survey - screenshots	Form	New	Available
User Satisfaction Survey	Form	New	Available
National Environmental Public Health Internship Program Survey	Form and Instruction	New	Available
Tox FAQs Before and After Testing Survey - Online	Form and Instruction	New	Available
0923-0047 Revision ATSDR Service Delivery SSB.docx	Supporting Statement B	Uploaded 2015-10-15	Available
0923-0047 Revision ATSDR Service Delivery SSA.docx	Supporting Statement A	Uploaded 2015-10-15	Available
CDC-specific Service Delivery 60-Day FRN 20140430.PDF	Supplementary Document	Uploaded 2015-10-06	Available
ATSDR Draft Generic Clearance for Qualitative Feedback Template Approval Form.docx	Supplementary Document	Uploaded 2013-05-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
233473	2018 Customer Satisfaction Survey for CDC NCEH NSMBB Laboratory Accredited to ISO 17043 (Proficiency Testing)	Form and Instruction	New	CDC Laboratory Customer Satisfaction Survey - CDC NCEH NSMBB Laboratory Proficiency Testing
232405	Sub-County Geocoding Standards Survey	Form and Instruction	New	Sub-County Geocoding Standards Survey
231810	Post-Meeting Survey of Attendees of 2018 Environmental PH Tracking Grantee Workshop	Form	New	Post-workshop survey - screenshots
231690	Customer Satisfaction Survey: Vessel Sanitation Program (VSP) Training Seminar	Form and Instruction	New	VSP Training Seminar Customer Satisfaction Survery Att. A
231640	Choose Safe Places for Early Care and Education Survey	Form and Instruction	New	ATSDR Choose Safe Places for Early Care and Education Survey
231638	NCEH/ATSDR Wellness Needs Assessment	Form and Instruction	New	NCEH/ATSDR Wellness Needs Assessment - Federal Employees/Contractors/Fellows
231065	NCEH/ATSDR Wellness Needs Assessment	Form and Instruction	New	NCEH/ATSDR Wellness Needs Assessment - Screenshot
230078	Post Meeting Survey of State, Local, and Tribal Government Attendees at the NACP Grantee Meeting 2018	Other-Paper version of survey (for reference only)	New
230078	Post Meeting Survey of State, Local, and Tribal Government Attendees at the NACP Grantee Meeting 2018	Form and Instruction	New	National Asthma Control Program Grantees Meeting Evaluation
229979	Post Meeting Survey of Non-Governmental Organization (NGO) Attendees at the NACP Grantee Meeting 2018	Other-Paper version of survey (for reference only)	New
229979	Post Meeting Survey of Non-Governmental Organization (NGO) Attendees at the NACP Grantee Meeting 2018	Form and Instruction	New	National Asthma Control Program Grantees Meeting Evaluation
229602	CDC GIS Website Content Strategy Survey	Form and Instruction	New	CDC GIS Website Content Strategy Survey
228469	Customer Satisfaction Survey for CDC Tobacco Products Laboratory Accredited to ISO/IEC 17025:2005	Form and Instruction	New	Tobacco Laboratory - Customer Service Survey
228383	Customer Satisfaction Survey for CDC NSMBB Laboratory Accredited to ISO 17043 (Proficiency Testing)	Form and Instruction	New	Customer Satisfaction Survey for the CDC Newborn Screening Quality Assurance Program
228069	CDC GIS Day Stakeholder Registration and Feedback	Form	New	Where in the World quiz
228069	CDC GIS Day Stakeholder Registration and Feedback	Form	New	Registration and Feedback
227992	CDC/ATSDR Needs Assessment of GIS use in Public Health Emergencies	Form	New	Attachment C GPHEW NA Survey Screenshots
227992	CDC/ATSDR Needs Assessment of GIS use in Public Health Emergencies	Form and Instruction	New	Attachment B GPHEW NA Survey Text
227850	Customer Feedback on ATSDR's Coping with Stress Fact Sheet	Form and Instruction	New	Feedback Form and Follow-up Interview Questions
227786	National ALS Registry Website Satisfaction Survey	Form	New	ALS Customer Satisfaction Survey - word
227786	National ALS Registry Website Satisfaction Survey	Form	New	ALS Customer Satisfaction Survey
227700	PFAS Exposure Assessment Technical Tools Feedback	Instruction	New
226993	Customer Satisfaction Survey: EATS/Food Defense training	Other-WORD	New
226803	Post-Meeti Survey of attendees at the APPLETREE Meeting 2017	Form and Instruction	New	Attachment C - APPLETREE Post Meeting Survey_text
226803	Post-Meeti Survey of attendees at the APPLETREE Meeting 2017	Form and Instruction	New	Attachment B - APPLETREE Post Meeting Survey_screenshot
226606	CDC's Social Vulnerability Index Webpage Survey	Form and Instruction	New	Survey for CDC's Social Vulnerability Index (SVI) Website - Screenshot
226085	NCEH/ATSDR Office of Science Regulatory Team Customer Satisfaction Survey	Form and Instruction	New	NCEH/ATSDR Office of Science Regulatory Team Customer Ssatisfaction Survey
225851	Usability Testing for the National	Instruction	New
225851	Usability Testing for the National	Form and Instruction	New	Attachment A - Respondent Screeners
224955	Council of State and Territorial Epidemiologists (CSTE) Feedback on Geospatial Capacity	Form	New	CSTE Feedback - Use of Geospatial Methods During Responses
222775	Transportation and Health Tool Website User Satisfaction Assessment	Instruction	New
222775	Transportation and Health Tool Website User Satisfaction Assessment	Form	New	User Satisfaction Survey - screenshots
222775	Transportation and Health Tool Website User Satisfaction Assessment	Form	New	User Satisfaction Survey
222751	National Environmental Public Health Internship Program Survey	Form and Instruction	New	National Environmental Public Health Internship Program Survey
219333	ToxFAQs Before and After Testing	Form and Instruction	New	Tox FAQs Before and After Testing Survey - Online

ICR Details

OMB Control No: 0923-0047	ICR Reference No: 201510-0923-001
Status: Historical Active	Previous ICR Reference No: 201305-0923-003
Agency/Subagency: HHS/TSDR	Agency Tracking No: 19457
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: 12/15/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/22/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2018	36 Months From Approved	05/31/2016
Responses	24,900	0	8,400
Time Burden (Hours)	21,225	0	7,275
Cost Burden (Dollars)	0	0	0

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Abstract: The 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:
	80 FR 61423	10/13/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 26

table that charts list of burden

IC Title	Form No.	Form Name
2018 Customer Satisfaction Survey for CDC NCEH NSMBB Laboratory Accredited to ISO 17043 (Proficiency Testing)	0920-1071	CDC Laboratory Customer Satisfaction Survey - CDC NCEH NSMBB Laboratory Proficiency Testing
CDC GIS Day Stakeholder Registration and Feedback	none, none	Registration and Feedback ,   Where in the World quiz
CDC GIS Website Content Strategy Survey	0923-0047	CDC GIS Website Content Strategy Survey
CDC's Social Vulnerability Index Webpage Survey	NA	Survey for CDC's Social Vulnerability Index (SVI) Website - Screenshot
CDC/ATSDR Needs Assessment of GIS use in Public Health Emergencies	0923-17AZF, 0923-17AZF	Attachment B GPHEW NA Survey Text ,   Attachment C GPHEW NA Survey Screenshots
Choose Safe Places for Early Care and Education Survey	0923-0047	ATSDR Choose Safe Places for Early Care and Education Survey
Council of State and Territorial Epidemiologists (CSTE) Feedback on Geospatial Capacity	N/A	CSTE Feedback - Use of Geospatial Methods During Responses
Customer Feedback on ATSDR's Coping with Stress Fact Sheet	n/a	Feedback Form and Follow-up Interview Questions
Customer Satisfaction Survey for CDC NSMBB Laboratory Accredited to ISO 17043 (Proficiency Testing)	n/a	Customer Satisfaction Survey for the CDC Newborn Screening Quality Assurance Program
Customer Satisfaction Survey for CDC Tobacco Products Laboratory Accredited to ISO/IEC 17025:2005	NA	Tobacco Laboratory - Customer Service Survey
Customer Satisfaction Survey: EATS/Food Defense training
Customer Satisfaction Survey: Vessel Sanitation Program (VSP) Training Seminar	0923-0047	VSP Training Seminar Customer Satisfaction Survery Att. A
NCEH/ATSDR Office of Science Regulatory Team Customer Satisfaction Survey	NA	NCEH/ATSDR Office of Science Regulatory Team Customer Ssatisfaction Survey
NCEH/ATSDR Wellness Needs Assessment	0923-0047	NCEH/ATSDR Wellness Needs Assessment - Screenshot
NCEH/ATSDR Wellness Needs Assessment	0923-0047	NCEH/ATSDR Wellness Needs Assessment - Federal Employees/Contractors/Fellows
National ALS Registry Website Satisfaction Survey	none, none	ALS Customer Satisfaction Survey ,   ALS Customer Satisfaction Survey - word
National Environmental Public Health Internship Program Survey	NA	National Environmental Public Health Internship Program Survey
PFAS Exposure Assessment Technical Tools Feedback
Post Meeting Survey of Non-Governmental Organization (NGO) Attendees at the NACP Grantee Meeting 2018	n/a	National Asthma Control Program Grantees Meeting Evaluation
Post Meeting Survey of State, Local, and Tribal Government Attendees at the NACP Grantee Meeting 2018	n/a	National Asthma Control Program Grantees Meeting Evaluation
Post-Meeti Survey of attendees at the APPLETREE Meeting 2017	17AIX, 17AIX	Attachment B - APPLETREE Post Meeting Survey_screenshot ,   Attachment C - APPLETREE Post Meeting Survey_text
Post-Meeting Survey of Attendees of 2018 Environmental PH Tracking Grantee Workshop	none	Post-workshop survey - screenshots
Sub-County Geocoding Standards Survey	0923-0047	Sub-County Geocoding Standards Survey
ToxFAQs Before and After Testing	NA	Tox FAQs Before and After Testing Survey - Online
Transportation and Health Tool Website User Satisfaction Assessment	none, none	User Satisfaction Survey ,   User Satisfaction Survey - screenshots
Usability Testing for the National	17wl	Attachment A - Respondent Screeners

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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	24,900	8,400	0	0	16,500	0
Annual Time Burden (Hours)	21,225	7,275	0	0	13,950	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase in burden and respondents is based on the Agency's anticipated number of upcoming GenICs during the next 3 years.

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Annual Cost to Federal Government: $500,000

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: 10/22/2015

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