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 0920-1050 Science Ambassador Regional Training Workshop Satisfaction Survey	Form and Instruction	New	Available
Form 0920-1050 Needs Assessment	Form and Instruction	New	Available
Customer Satisfaction Survey	Form	New	Available
Form 0920-1050 CUSTOMER SATISFACTION SURVEY: CDC’S PAGE INFO TAB	Form and Instruction	New	Available
Form 0920-1050 APIH - AACN ORIENTATON SURVEY	Form	New	Available
Form 0920-1050 APIH - ASPPH ORIENTATION SURVY	Form	New	Available
APIH Training Feedback Survey	Form	New	Repair queued
Form 0920-1050 0920-1050	Form and Instruction	New	Available
Form 0920-1050 Feedback for 2018 Place & Health Conference	Form and Instruction	New	Available
Form 0920-1050 PHE Forum Survey	Form and Instruction	New	Available
Training Assessment	Form	New	Available
Form 0920-1050 DataViz Day Needs Assessment	Form and Instruction	New	Source copy available
Form 0920-1050 Science Ambassador Fellowship Exit Satisfaction Survey - Screenshot	Form and Instruction	New	Available
Session 3 survey	Form	New	Available
Session 1 survey	Form	New	Available
Session 2 survey	Form	New	Available
2018 Science Ambassador Fellowship Summer Course Satisfaction Survey	Form	New	Available
Form 0920-1050 PHEMF Feedback	Form and Instruction	New	Available
Form 0920-1050 National DDP Customer Service Center -- Surveys Along the Customer Journey	Form and Instruction	New	Available
Form 0920-1050 2019 Federal Select Agent Program Inspection Feedback Survey	Form	New	Available
Form 0920-1050 EIS Conference Customer Service Feedback Survey - Screenshots	Form and Instruction	New	Available
Assessment	Form	New	Available
Form 0920-1050 GOV.D Survey Questions	Form and Instruction	New	Available
Form 0920-1050 MosquitoNET Focus Group Discussion Guide	Form and Instruction	New	Available
2018 ITSO Customer Satisfaction Survey	Form	New	Available
Form 0920-1050 Customer Satisfaction Survey: CDC Fellowships, Internships, and Learning Opportunities GovDelivery (GovD) Newsletter - Screenshot	Form and Instruction	New	Available
Customer Satisfaction Survey	Form	New	Available
Flu Email Updates Survey	Form and Instruction	New	Available
Form 0920-17AUP Attachment C_LTBI Mobile App Survey_Potential Users_Screenshots	Form and Instruction	New	Available
Form 0920-17AUP Attachment B_LTBI Mobile App Survey_Current Users_Screenshots	Form and Instruction	New	Available
Form 0920-17AUP Attachment A_LTBI Mobile App Survey Questions	Form and Instruction	New	Available
TB Survey - screenshots	Form	New	Available
TB Survey - word	Form	New	Available
DSTDP Assessment: HIV testing in SSuN STD Clinics - STD Clinic/Data Manager Interview Guide	Form and Instruction	New	Available
DSTDP Assessment: HIV testing in SSuN STD Clinics - STD Clinic Provider Interview Guide	Form and Instruction	New	Available
Form 0920-17ANW Att_2_0920-1050_2017_Science_Amb_Fwshp_Sum_Course_Cust_Sat_Survey_Screen...	Form and Instruction	New	Available
Form 0920-17ANW Att_1_0920-1050_2017_Science_Amb_Fwshp_Sum_Course_Cust_Sat_Survey_Subm	Form and Instruction	New	Available
2017 EIS Conference Customer Service Feedback Survey - Screenshot	Form and Instruction	New	Available
Solve the Outbreak (Student version)	Form	New	Available
Solve the Outbreak (Teacher version)	Form	New	Available
Solve the Outbreak (General Public version)	Form	New	Available
Form 17WN Att 1. Instrument_Peer Reviewers' Evaluation Form 3.2.17	Form and Instruction	New	Available
Technical Package Violence Prevention Survey	Form	New	Available
2017 ITSO Customer Satisfaction Survey - Global	Form and Instruction	New	Available
2017 ITSO Customer Satisfaction Survey - Domestic	Form and Instruction	New	Available
Form 0920-1050 17FZ	Form and Instruction	New	Available
CDC Laboratory Customer Satisfaction Survey (web version)	Form	New	Available
CDC Laboratory Cusomter Satisfaction Survey (paper version)	Form	New	Available
CDC-INFO Email Survey	Form	New	Available
Public Health Grand Rounds Survey	Form	New	Available
ZIKA USABILITY TEST: NOTETAKING DOCUMENT	Form and Instruction	New	Available
CDC Zika website User Experience (UX): Questionnaire	Form and Instruction	New	Available
2016 Science Ambassador Workshop Satisfaction Survey	Form and Instruction	New	Available
SSB fast track revision.docx	Supporting Statement B	Uploaded 2016-05-02	Available
SSA fast track revision.docx	Supporting Statement A	Uploaded 2016-05-02	Available
60dayFRN..pdf	Supplementary Document	Uploaded 2014-11-24	Available
GenIC Clearance Template.docx	Supplementary Document	Uploaded 2014-11-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
235100	2019 Science Ambassador Fellowship Regional Training Workshop Customer Satisfaction Survey	Form and Instruction	New	Science Ambassador Regional Training Workshop Satisfaction Survey
235100	2019 Science Ambassador Fellowship Regional Training Workshop Customer Satisfaction Survey	Other-WORD	New
234909	Disaster Response Training Needs Assessment	Form and Instruction	New	Needs Assessment
234903	Understanding the Use of CDC Resources and Tools during 2017 Hurricane Disaster Response	Other-WORD (English)	New
234900	Office of Scientific Integrity Customer Satisfaction Survey	Form	New	Customer Satisfaction Survey
234834	CDC Page Info Tab	Form and Instruction	New	CUSTOMER SATISFACTION SURVEY: CDC’S PAGE INFO TAB
234727	APIH Fellowship Program Orientation Survey	Form	New	APIH - AACN ORIENTATON SURVEY
234727	APIH Fellowship Program Orientation Survey	Form	New	APIH - ASPPH ORIENTATION SURVY
234678	Web Usability Study for CDC's Radiation Emergencies Website	Other-WORD	New
234628	Academic Partnerships to Improve Health (APIH) Program Training/Workshop Feedback Survey (January – June, 2019)	Form	New	APIH Training Feedback Survey
234516	Post-Meeting Survey of Attendees at the 2018 Childhood Lead Poisoning Prevention Annual Cooperative Agreement Recipient's Meeting	Form and Instruction	New	0920-1050
233529	Feedback for 2018 Place & Health Conference	Form and Instruction	New	Feedback for 2018 Place & Health Conference
233474	Assessing Customer Satisfaction with Health, US Report	Other-Interview guide	New
233464	Customer Feedback on CDC CVD Policy Platform	Other-WORD	New
232985	2018 Public Health Ethics Forum	Form and Instruction	New	PHE Forum Survey
232825	Participant Assessment of Science Integrity Branch Trainings	Form	New	Training Assessment
232760	CDC DataViz Day Needs Assessment	Form and Instruction	New	DataViz Day Needs Assessment
232303	2018 Science Ambassador Fellowship Exit Satisfaction Survey	Form and Instruction	New	Science Ambassador Fellowship Exit Satisfaction Survey - Screenshot
232216	2018 CUPS/Ferguson Summer Showcase	Form	New	Session 3 survey
232216	2018 CUPS/Ferguson Summer Showcase	Form	New	Session 1 survey
232216	2018 CUPS/Ferguson Summer Showcase	Form	New	Session 2 survey
231619	2018 Science Ambassador Fellowship Summer Course Satisfaction Survey	Form	New	2018 Science Ambassador Fellowship Summer Course Satisfaction Survey
231619	2018 Science Ambassador Fellowship Summer Course Satisfaction Survey	Other-Reference document: Word version of survey content	New
231504	CDC Public Health Emergency Management Fellowship Feedback	Form and Instruction	New	PHEMF Feedback
231415	Emergency Partners Information Connection (EPIC) Partner Interaction	Other-Survey script	New
231398	National Diabetes Prevention Program Customer Service Center (National DPP CSC) -- Customer Satisfactory Surveys	Form and Instruction	New	National DDP Customer Service Center -- Surveys Along the Customer Journey
231183	2018 Federal Select Agents Program Inspection Feedback Survey	Form	New	2019 Federal Select Agent Program Inspection Feedback Survey
230262	Customer Service Feedback Survey of 2018 EIS Conference	Form and Instruction	New	EIS Conference Customer Service Feedback Survey - Screenshots
230232	Adapting Clnical Guidelines for the Digital Age Meeting Assessment	Form	New	Assessment
230010	CDC Learning Connection Gov D Newsletter Survey	Form and Instruction	New	GOV.D Survey Questions
230010	CDC Learning Connection Gov D Newsletter Survey	Other-Screenshots	New
229959	MosquitoNet Surveillance System Focus Group	Form and Instruction	New	MosquitoNET Focus Group Discussion Guide
229828	CDC Template Navigation	Other-Discussion guide	New
229412	2018 ITSO Customer Satisfaction Survey	Form	New	2018 ITSO Customer Satisfaction Survey
229110	CDC Fellowships, Internships, and Learning Opportunities GovDelivery Newsletter Customer Satisfaction Survey	Form and Instruction	New	Customer Satisfaction Survey: CDC Fellowships, Internships, and Learning Opportunities GovDelivery (GovD) Newsletter - Screenshot
228553	Education and Training Services Branch Customer Satisfaction Survey	Form	New	Customer Satisfaction Survey
228181	Seasonal Flu: Email Updates Satisfaction Survey	Form and Instruction	New	Flu Email Updates Survey
227641	CDC Latent Tuberculosis Infection Mobile App Survey	Form and Instruction	New	Attachment C_LTBI Mobile App Survey_Potential Users_Screenshots
227641	CDC Latent Tuberculosis Infection Mobile App Survey	Form and Instruction	New	Attachment B_LTBI Mobile App Survey_Current Users_Screenshots
227641	CDC Latent Tuberculosis Infection Mobile App Survey	Form and Instruction	New	Attachment A_LTBI Mobile App Survey Questions
227258	TB Training and Education Needs Assessment of the US-affiliated Pacific Islands and Hawaii	Form	New	TB Survey - screenshots
227258	TB Training and Education Needs Assessment of the US-affiliated Pacific Islands and Hawaii	Form	New	TB Survey - word
227197	Partner Feedback Assessment Of Sexually Transmitted Disease (STD) Clinic Processes For Conducting And Documenting Routine HIV Testing	Form and Instruction	New	DSTDP Assessment: HIV testing in SSuN STD Clinics - STD Clinic/Data Manager Interview Guide
227197	Partner Feedback Assessment Of Sexually Transmitted Disease (STD) Clinic Processes For Conducting And Documenting Routine HIV Testing	Form and Instruction	New	DSTDP Assessment: HIV testing in SSuN STD Clinics - STD Clinic Provider Interview Guide
227101	2017 Science Ambassador Fellowship Summer Course Satisfaction Survey	Form and Instruction	New	Att_2_0920-1050_2017_Science_Amb_Fwshp_Sum_Course_Cust_Sat_Survey_Screen...
227101	2017 Science Ambassador Fellowship Summer Course Satisfaction Survey	Form and Instruction	New	Att_1_0920-1050_2017_Science_Amb_Fwshp_Sum_Course_Cust_Sat_Survey_Subm
226545	Customer Service Feedback Survey of 2017 EIS Conference	Form and Instruction	New	2017 EIS Conference Customer Service Feedback Survey - Screenshot
226008	CDC Solve the Outbreak Mobile App	Form	New	Solve the Outbreak (Student version)
226008	CDC Solve the Outbreak Mobile App	Form	New	Solve the Outbreak (Teacher version)
226008	CDC Solve the Outbreak Mobile App	Form	New	Solve the Outbreak (General Public version)
225960	Special Emphasis Panel (SEP) Peer Review Evaluation	Form and Instruction	New	Att 1. Instrument_Peer Reviewers' Evaluation Form 3.2.17
225691	Technical Packages for Violence Prevention Using Evidence-based Strategies in Your Violence Prevention Efforts Online Survey	Form	New	Technical Package Violence Prevention Survey
225380	ITSO Customer Satisfaction Survey	Form and Instruction	New	2017 ITSO Customer Satisfaction Survey - Global
225380	ITSO Customer Satisfaction Survey	Form and Instruction	New	2017 ITSO Customer Satisfaction Survey - Domestic
225142	CDC-INFO Interactive Voice Response Survey	Form and Instruction	New	17FZ
224757	Customer Satisfaction Survey for 5 CDC Laboratories Seeking ISO 17025 Accreditation for Laboratory Quality	Form	New	CDC Laboratory Customer Satisfaction Survey (web version)
224757	Customer Satisfaction Survey for 5 CDC Laboratories Seeking ISO 17025 Accreditation for Laboratory Quality	Form	New	CDC Laboratory Cusomter Satisfaction Survey (paper version)
224698	CDC-INFO Email Survey	Form	New	CDC-INFO Email Survey
223551	FLU Vaccines Section Usability Testing	Other-Screenshots	New
222920	CDC Public Health Grand Rounds Audience Satisfaction Survey	Form	New	Public Health Grand Rounds Survey
222246	CDC Zika Website	Form and Instruction	New	ZIKA USABILITY TEST: NOTETAKING DOCUMENT
222246	CDC Zika Website	Form and Instruction	New	CDC Zika website User Experience (UX): Questionnaire
222177	2016 Science Ambassador Workshop Satisfaction Survey	Form and Instruction	New	2016 Science Ambassador Workshop Satisfaction Survey

ICR Details

OMB Control No: 0920-1050	ICR Reference No: 201605-0920-001
Status: Historical Active	Previous ICR Reference No: 201411-0920-012
Agency/Subagency: HHS/CDC	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: 06/09/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/10/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2019	36 Months From Approved	02/28/2018
Responses	206,400	0	17,400
Time Burden (Hours)	60,750	0	11,550
Cost Burden (Dollars)	0	0	0

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Abstract: This 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. Revision request to add respondents and burden.

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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:
	81 FR 27134	05/05/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 47

table that charts list of burden

IC Title	Form No.	Form Name
2016 Science Ambassador Workshop Satisfaction Survey	NA	2016 Science Ambassador Workshop Satisfaction Survey
2017 Science Ambassador Fellowship Summer Course Satisfaction Survey	0920-17ANW, 0920-17ANW	Att_1_0920-1050_2017_Science_Amb_Fwshp_Sum_Course_Cust_Sat_Survey_Subm ,   Att_2_0920-1050_2017_Science_Amb_Fwshp_Sum_Course_Cust_Sat_Survey_Screen...
2018 CUPS/Ferguson Summer Showcase	none, none, none	Session 2 survey ,   Session 1 survey ,   Session 3 survey
2018 Federal Select Agents Program Inspection Feedback Survey	0920-1050	2019 Federal Select Agent Program Inspection Feedback Survey
2018 ITSO Customer Satisfaction Survey	none	2018 ITSO Customer Satisfaction Survey
2018 Public Health Ethics Forum	0920-1050	PHE Forum Survey
2018 Science Ambassador Fellowship Exit Satisfaction Survey	0920-1050	Science Ambassador Fellowship Exit Satisfaction Survey - Screenshot
2018 Science Ambassador Fellowship Summer Course Satisfaction Survey	n/a	2018 Science Ambassador Fellowship Summer Course Satisfaction Survey
2019 Science Ambassador Fellowship Regional Training Workshop Customer Satisfaction Survey	0920-1050	Science Ambassador Regional Training Workshop Satisfaction Survey
APIH Fellowship Program Orientation Survey	0920-1050, 0920-1050	APIH - ASPPH ORIENTATION SURVY ,   APIH - AACN ORIENTATON SURVEY
Academic Partnerships to Improve Health (APIH) Program Training/Workshop Feedback Survey (January – June, 2019)	n/a	APIH Training Feedback Survey
Adapting Clnical Guidelines for the Digital Age Meeting Assessment	none	Assessment
Assessing Customer Satisfaction with Health, US Report
CDC DataViz Day Needs Assessment	0920-1050	DataViz Day Needs Assessment
CDC Fellowships, Internships, and Learning Opportunities GovDelivery Newsletter Customer Satisfaction Survey	0920-1050	Customer Satisfaction Survey: CDC Fellowships, Internships, and Learning Opportunities GovDelivery (GovD) Newsletter - Screenshot
CDC Latent Tuberculosis Infection Mobile App Survey	0920-17AUP, 0920-17AUP, 0920-17AUP	Attachment A_LTBI Mobile App Survey Questions ,   Attachment B_LTBI Mobile App Survey_Current Users_Screenshots ,   Attachment C_LTBI Mobile App Survey_Potential Users_Screenshots
CDC Learning Connection Gov D Newsletter Survey	0920-1050	GOV.D Survey Questions
CDC Page Info Tab	0920-1050	CUSTOMER SATISFACTION SURVEY: CDC’S PAGE INFO TAB
CDC Public Health Emergency Management Fellowship Feedback	0920-1050	PHEMF Feedback
CDC Public Health Grand Rounds Audience Satisfaction Survey	none	Public Health Grand Rounds Survey
CDC Solve the Outbreak Mobile App	N/A, N/A, N/A	Solve the Outbreak (General Public version) ,   Solve the Outbreak (Teacher version) ,   Solve the Outbreak (Student version)
CDC Template Navigation
CDC Zika Website	NA, NA	CDC Zika website User Experience (UX): Questionnaire ,   ZIKA USABILITY TEST: NOTETAKING DOCUMENT
CDC-INFO Email Survey	none	CDC-INFO Email Survey
CDC-INFO Interactive Voice Response Survey	0920-1050	17FZ
Customer Feedback on CDC CVD Policy Platform
Customer Satisfaction Survey for 5 CDC Laboratories Seeking ISO 17025 Accreditation for Laboratory Quality	N/A, N/A	CDC Laboratory Cusomter Satisfaction Survey (paper version) ,   CDC Laboratory Customer Satisfaction Survey (web version)
Customer Service Feedback Survey of 2017 EIS Conference	NA	2017 EIS Conference Customer Service Feedback Survey - Screenshot
Customer Service Feedback Survey of 2018 EIS Conference	0920-1050	EIS Conference Customer Service Feedback Survey - Screenshots
Disaster Response Training Needs Assessment	0920-1050	Needs Assessment
Education and Training Services Branch Customer Satisfaction Survey	none	Customer Satisfaction Survey
Emergency Partners Information Connection (EPIC) Partner Interaction
FLU Vaccines Section Usability Testing
Feedback for 2018 Place & Health Conference	0920-1050	Feedback for 2018 Place & Health Conference
ITSO Customer Satisfaction Survey	NA, NA	2017 ITSO Customer Satisfaction Survey - Domestic ,   2017 ITSO Customer Satisfaction Survey - Global
MosquitoNet Surveillance System Focus Group	0920-1050	MosquitoNET Focus Group Discussion Guide
National Diabetes Prevention Program Customer Service Center (National DPP CSC) -- Customer Satisfactory Surveys	0920-1050	National DDP Customer Service Center -- Surveys Along the Customer Journey
Office of Scientific Integrity Customer Satisfaction Survey	none	Customer Satisfaction Survey
Participant Assessment of Science Integrity Branch Trainings	none	Training Assessment
Partner Feedback Assessment Of Sexually Transmitted Disease (STD) Clinic Processes For Conducting And Documenting Routine HIV Testing	NA, NA	DSTDP Assessment: HIV testing in SSuN STD Clinics - STD Clinic Provider Interview Guide ,   DSTDP Assessment: HIV testing in SSuN STD Clinics - STD Clinic/Data Manager Interview Guide
Post-Meeting Survey of Attendees at the 2018 Childhood Lead Poisoning Prevention Annual Cooperative Agreement Recipient's Meeting	0920-1050	0920-1050
Seasonal Flu: Email Updates Satisfaction Survey	NA	Flu Email Updates Survey
Special Emphasis Panel (SEP) Peer Review Evaluation	17WN	Att 1. Instrument_Peer Reviewers' Evaluation Form 3.2.17
TB Training and Education Needs Assessment of the US-affiliated Pacific Islands and Hawaii	none, none	TB Survey - word ,   TB Survey - screenshots
Technical Packages for Violence Prevention Using Evidence-based Strategies in Your Violence Prevention Efforts Online Survey	none	Technical Package Violence Prevention Survey
Understanding the Use of CDC Resources and Tools during 2017 Hurricane Disaster Response
Web Usability Study for CDC's Radiation Emergencies Website

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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	206,400	17,400	0	189,000	0	0
Annual Time Burden (Hours)	60,750	11,550	0	49,200	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: Burden increase due to anticipating additional collections to absorb discontinuing clearances (0920-1003 and 0920-0998).

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Annual Cost to Federal Government: $55,000

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 05/10/2016

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