GenIC Request

Request for Approval under the “Generic Clearance for the Collection of
Routine Customer Feedback” (OMB Control Number: 0923-0047)
TITLE OF INFORMATION COLLECTION: NCEH/ATSDR Office of Science Regulatory
Team Customer Satisfaction Survey
PURPOSE: The purpose of this information collection is to collect feedback from staff within
NCEH/ATSDR on the regulatory services provided by the NCEH/ATSDR Office of Science
(OS) Regulatory team. The proposed information collection consists of a survey designed to
assess: 1) overall satisfaction with services provided by the Regulatory team; 2) overall
satisfaction with OS turnaround time for requests; 3) regulatory training needs and preferred
mode of training; 4) satisfaction with the current OS Regulatory team intranet site and resources
available on the site; and 5) NCEH/ATSDR staffs’ primary source of support for human subjects
and Office of Management and Budget (OMB) Paperwork Reduction Act (PRA) related issues.
Information collected from the survey will be used to improve the services provided by the OS
Regulatory team and to customize desired regulatory training for each division within
NCEH/ATSDR.
DESCRIPTION OF RESPONDENTS: The online survey questionnaire will be offered to all
federal employees, contractors, fellows, and staff within NCEH/ATSDR who have worked with
the NCEH/ATSDR Office of Science Regulatory team within the past 1 year.
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.
Digitally signed by Alisha Etheredge -S
DN: c=US, o=U.S. Government, ou=HHS, ou=CDC, ou=People,
0.9.2342.19200300.100.1.1=1000311055, cn=Alisha Etheredge -S
Date: 2017.03.01 13:12:25 -05'00'

Alisha Etheredge -S
Name:________________________________________________
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, is the information that will be collected included in records that are subject to the
Privacy Act of 1974? [ ] Yes [ X ] No
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3. If Applicable, has a System or Records Notice been published? [ ] Yes [ X ] No
Gifts or Payments:
Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to
participants? [ ] Yes [ X ] No

BURDEN HOURS
We expect an 80% response rate for the online survey questionnaire.
Category of Respondent

No. of
Respondents
50
20
70

Federal government employees
Contractors/Fellows
Totals

Participation
Time
15/60
15/60

Burden
12.5 hrs
5 hrs
17.5 hrs

FEDERAL COST: The estimated annual cost to the Federal government is $188. This cost
reflects approximately 5 hours of salary for one staff person to: 1) design and implement the
survey; and 2) draft an internal report of results.
The annual cost associated with respondent burden hours is approximately $858.
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?
An email (Attachment A) will be sent to the Associate Director of Science (ADS) for each of the
five divisions within NCEH/ATSDR (see below). The email will request that the ADS distribute
the respondent email invitation (Attachment B) to staff within their division who have used
regulatory services offered by the OS Regulatory team.
NCEH/ATSDR Associate Directors of Science:
Division of Laboratory Sciences – Jerry Thomas
Division of Community Health Investigations – Tina Forrester
Division of Toxicology and Human Health Sciences – Lina Balluz
Division of Emergency and Environmental Health Services – Helen Schurz-Rogers
Division of Environmental Hazards and Health Effects – Josephine Malilay
Administration of the Instrument

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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
SurveyMonkey® will be used to collect the online survey responses. The use of SurveyMonkey®
has been reviewed and approved to be compliant with HHS IT security standards. An IT
security plan is in place for this application.
Please make sure that all instruments, instructions, and scripts are submitted with the
request.
The following attachments are included:
Attachment A – ADS Email Request Letter
Attachment B – Respondent Email Invitation
Attachment C – NCEH/ATSDR OS Regulatory Team Customer Satisfaction Survey (text)
Attachment D – NCEH/ATSDR OS Regulatory Team Customer Satisfaction Survey (online)

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Instructions for completing Request for Approval under the “Generic
Clearance for the Collection of Routine Customer Feedback”
TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the
subject of the request. (e.g. Comment card for soliciting feedback on xxxx)
PURPOSE: Provide a brief description of the purpose of this collection and how it will be used.
If this is part of a larger study or effort, please include this in your explanation.
DESCRIPTION OF RESPONDENTS: Provide a brief description of the targeted group or
groups for this collection of information. These groups must have experience with the program.
TYPE OF COLLECTION: Check one box. If you are requesting approval of other
instruments under the generic, you must complete a form for each instrument.
CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the
collection will be returned as improperly submitted or it will be disapproved.
Personally Identifiable Information: Provide answers to the questions.
Gifts or Payments: If you answer yes to the question, please describe the incentive and provide
a justification for the amount.
BURDEN HOURS:
Category of Respondents: Identify who you expect the respondents to be in terms of the
following categories: (1) Individuals or Households; (2) Private Sector; (3) State, local, or tribal
governments; or (4) Federal Government. Only one type of respondent can be selected.
No. of Respondents: Provide an estimate of the Number of respondents.
Participation Time: Provide an estimate of the amount of time required for a respondent to
participate (e.g. fill out a survey or participate in a focus group)
Burden: Provide the Annual burden hours: Multiply the Number of responses and the
participation time and divide by 60.
FEDERAL COST: Provide an estimate of the annual cost to the Federal government.
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. Please provide a description of how you plan to
identify your potential group of respondents and how you will select them. If the answer is yes,
to the first question, you may provide the sampling plan in an attachment.
Administration of the Instrument: Identify how the information will be collected. More than
one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or
facilitators (e.g., for focus groups) used.

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Please make sure that all instruments, instructions, and scripts are submitted with the
request.

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