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 0920-0974 Customer Satisfaction Survey	Form and Instruction	New	Available
Form 0920-0974 CDC Fellowship Applicant Customer Satisfaction Survey	Form and Instruction	New	Available
Form 0920-0974 Learner Feedback Survey	Form and Instruction	New	Available
Learner Feedback Survey	Form	New	Available
Science Ambassador Fellowship Exit Satisfaction Survey	Form	New	Available
Form 0920-1173 Survey (Exposure to Arsenic an Uranium in Private Well Water in Connecticut, New Mexico, and New Hampshire	Form	New	Available
Form 0920-1173 Food and Bathing Log	Form and Instruction	New	Available
Form 0920-1173 Screening Survey	Form	New	Available
2019 Science Ambassador Fellowship Summer Course Satisfaction Survey	Form and Instruction	New	Available
Form 0920-0974 2019 ELI Fellowship Survey	Form and Instruction	New	Available
Form 0920-0974 CDC 2019 Mycobacterium tuberculosis Diagnostic Principles and Procedures - Course Learner Feedback Survey	Form and Instruction	New	Available
Form n/q Interview Guide	Form and Instruction	New	Available
Pre-interview Questionnaire	Form and Instruction	New	Available
Pre-focus group questionnaire	Form	New	Available
Diagnostic Parasitology Learner Feedback Survey	Form	New	Available
Pre-Focus Group Questionnaire	Form and Instruction	New	Available
2019 EIS Conference Survey	Form	New	Available
Form 0920-0974 Focus Group Guide	Form and Instruction	New	Available
Form 0920-0974 Pre-Focus Group Questionnaire	Form and Instruction	New	Available
Form 0920-0974 Rabies Course Feedback Survey	Form and Instruction	New	Available
Form 0920-0974 Mtuberculosis Course Survey	Form and Instruction	New	Available
Form 0920-0974 Laboratory Identification of Emerging Pathogenic Molds Course Learner Feedback Survey	Form and Instruction	New	Available
Form 0920-0974 (18AVD) 2018 Good Laboratory Practices for Molecular Genetic Testing Elearning Course Learner Feedback Survey	Form and Instruction	New	Available
Form 0920-0974 (!!*ASY) 2018 Public Health and Preparedness Webinar Learner Feedback Survey	Form and Instruction	New	Available
Form 0920-0974 2018 Public Health and Preparedness Webinar Learner Feedback Survey	Form and Instruction	New	Available
2018 Packaging and Shipping Division 6.2 Materials eLearning Course Feedback Survey	Form and Instruction	New	Available
Form 0920-0974 Microbiology-Oriented eLearning Feedback	Form and Instruction	New	Available
Anticoagulation Manager Mobile App User Survey	Form	New	Available
Applicability and Use of The Community Guide Among NACCHO Members (screenshots)	Form and Instruction	New	Available
SAMHSA Grantees Survey	Form	New	Available
Form 0920-0974 03_Screen shots of IQCP Workbook Survey 01-19-2017	Form	New	Available
Survey of 2017 NSSP Grantee Meeting	Form	New	Available
Form 0920-17FC Genomics Survey for Webinar 2016_11_18	Form and Instruction	New	Available
CSELS Extension 0920-0974 Service Delivery GenIC Request Template.docx	Supplementary Document	Uploaded 2016-06-09	Available
CSELS Revision 0920-0974 Service Delivery GenIC Request Supporting Statement - Part B.docx	Supporting Statement B	Uploaded 2016-06-09	Available
REV CSELS Revision 0920-0974 Service Delivery Generic Request Supporting Statement - Part A.docx	Supporting Statement A	Uploaded 2016-06-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
237491	2019 Science Ambassador Training Customer Satisfaction Survey	Form and Instruction	New	Customer Satisfaction Survey
237191	EIS and LLS Class of 2020 Applicant Customer Satisfaction Survey	Form and Instruction	New	CDC Fellowship Applicant Customer Satisfaction Survey
237191	EIS and LLS Class of 2020 Applicant Customer Satisfaction Survey	Other-Survey (screenshots)	New
237143	CDC Introduction to Informatics: Life of a Specimen and Life of a Result eLearning Courses Learner Feedback Survey	Form and Instruction	New	Learner Feedback Survey
236771	CDC Public Health and Preparedness Webinar Feedback Survey	Form	New	Learner Feedback Survey
236620	2018 Science Ambassador Fellowship Exit Satisfaction Survey	Form	New	Science Ambassador Fellowship Exit Satisfaction Survey
236443	Exposure to Arsenic and Uranium in Private Well Water in Connecticut New Mexico and New Hampshire	Form	New	Survey (Exposure to Arsenic an Uranium in Private Well Water in Connecticut, New Mexico, and New Hampshire
236443	Exposure to Arsenic and Uranium in Private Well Water in Connecticut New Mexico and New Hampshire	Form and Instruction	New	Food and Bathing Log
236443	Exposure to Arsenic and Uranium in Private Well Water in Connecticut New Mexico and New Hampshire	Form	New	Screening Survey
236443	Exposure to Arsenic and Uranium in Private Well Water in Connecticut New Mexico and New Hampshire	Instruction	New
236433	2019 Science Ambassador Fellowship Summer Course Satisfaction Survey	Form and Instruction	New	2019 Science Ambassador Fellowship Summer Course Satisfaction Survey
236433	2019 Science Ambassador Fellowship Summer Course Satisfaction Survey	Other-Word version of the survey to facilitate review of survey	New
236424	2019 ELI Fellowship End of Year Evaluation Survey	Form and Instruction	New	2019 ELI Fellowship Survey
236409	Mycobacterium tuberculosis: Diagnostic Principles and Procedures Course Learner Feedback Survey	Form and Instruction	New	CDC 2019 Mycobacterium tuberculosis Diagnostic Principles and Procedures - Course Learner Feedback Survey
236116	Clinical Laboratory Interview Feedback on DLS Professional Development Service Offerings	Form and Instruction	New	Interview Guide
236116	Clinical Laboratory Interview Feedback on DLS Professional Development Service Offerings	Form and Instruction	New	Pre-interview Questionnaire
235927	Public Health Laboratory Feedback on DLS Professional Development Service Offerings	Form	New	Pre-focus group questionnaire
235927	Public Health Laboratory Feedback on DLS Professional Development Service Offerings	Other-Interview Guide	New
235689	Diagnostic Parasitology Course Feedback	Form	New	Diagnostic Parasitology Learner Feedback Survey
235660	Clinical laboratory focus group feedback on DLS professional development service offerings	Form and Instruction	New	Pre-Focus Group Questionnaire
235660	Clinical laboratory focus group feedback on DLS professional development service offerings	Other-Focus group guide	New
235507	Customer Service Feedback Survey of 2019 EIS Conference	Form	New	2019 EIS Conference Survey
235481	Public Health Laboratory Focus Group Feedback on DLS Professional Development Services Offerings	Form and Instruction	New	Focus Group Guide
235481	Public Health Laboratory Focus Group Feedback on DLS Professional Development Services Offerings	Form and Instruction	New	Pre-Focus Group Questionnaire
235203	Laboratory Methods for Detecting Rabies Virus Course Learner Feedback Survey	Form and Instruction	New	Rabies Course Feedback Survey
233951	Good Laboratory Practices for Biochemical Genetic Testing Preanalytic Phase eLearning Course Learner Feedback Survey	Other-Screenshots	New
233071	Mycobacterium tuberculosis: Diagnostic Principles and Procedures Course Learner Feedback Survey	Form and Instruction	New	Mtuberculosis Course Survey
232805	Laboratory Identification of Emerging Pathogenic Molds Course Learner Feedback Survey	Form and Instruction	New	Laboratory Identification of Emerging Pathogenic Molds Course Learner Feedback Survey
232633	Good Laboratory Practices for Molecular Genetic Testing eLearning Course Learner Feedback	Form and Instruction	New	2018 Good Laboratory Practices for Molecular Genetic Testing Elearning Course Learner Feedback Survey
232633	Good Laboratory Practices for Molecular Genetic Testing eLearning Course Learner Feedback	Instruction	New
232622	Public Health and Prepareness Webinars Learner Feedback Survey	Form and Instruction	New	2018 Public Health and Preparedness Webinar Learner Feedback Survey
232622	Public Health and Prepareness Webinars Learner Feedback Survey	Instruction	New
232362	Good Laboratory Practices for Molecular Genetic Testing Learner Feedback Survey	Form and Instruction	New	2018 Public Health and Preparedness Webinar Learner Feedback Survey
232362	Good Laboratory Practices for Molecular Genetic Testing Learner Feedback Survey	Other-Screenshots	New
232357	Packaging and Shipping Division 6.2 Materials eLearning Course Learner Feedback Survey	Form and Instruction	New	2018 Packaging and Shipping Division 6.2 Materials eLearning Course Feedback Survey
232348	Microbiology-Oriented eLearning Courses Learner Feedback Survey	Form and Instruction	New	Microbiology-Oriented eLearning Feedback
229982	Anticoagulation Manager Mobile App User Feedback	Form	New	Anticoagulation Manager Mobile App User Survey
227541	BioSense Platform User Satisfaction Survey	Other-WORD	New
227194	Individualized Quality Control Plan Workbook Survey	Other-Online	New
225548	Applicability and Use of The Community Guide Among National Association of County and City Health Officials (NACCHO) Members	Form and Instruction	New	Applicability and Use of The Community Guide Among NACCHO Members (screenshots)
225311	Evaluating the Applicability and Use of The Commmunity Guide among SAMHSA Grantees	Form	New	SAMHSA Grantees Survey
225310	Individualized Quality Control Plan Workbook Survey	Form	New	03_Screen shots of IQCP Workbook Survey 01-19-2017
225310	Individualized Quality Control Plan Workbook Survey	Instruction	New
225110	Genomics and Population Health Action Collaborative (GPHAC) Interviews	Other-WORD	New
224854	Feedback Survey of 2017 NSSP Annual Grantee Meeting	Form	New	Survey of 2017 NSSP Grantee Meeting
224566	Implementing Public Health Genomics in Your State: Resources from CDC Office of Public Health	Form and Instruction	New	Genomics Survey for Webinar 2016_11_18
224566	Implementing Public Health Genomics in Your State: Resources from CDC Office of Public Health	Instruction	New

ICR Details

OMB Control No: 0920-0974	ICR Reference No: 201606-0920-007
Status: Historical Active	Previous ICR Reference No: 201305-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No: 19639
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: 10/05/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/15/2016
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	10/31/2019	36 Months From Approved	10/31/2016
Responses	187,746	0	60,720
Time Burden (Hours)	50,871	0	41,799
Cost Burden (Dollars)	0	0	0

---

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.

---

Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

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 38184	06/13/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 33

table that charts list of burden

IC Title	Form No.	Form Name
2018 Science Ambassador Fellowship Exit Satisfaction Survey	none	Science Ambassador Fellowship Exit Satisfaction Survey
2019 ELI Fellowship End of Year Evaluation Survey	0920-0974	2019 ELI Fellowship Survey
2019 Science Ambassador Fellowship Summer Course Satisfaction Survey	n/a	2019 Science Ambassador Fellowship Summer Course Satisfaction Survey
2019 Science Ambassador Training Customer Satisfaction Survey	0920-0974	Customer Satisfaction Survey
Anticoagulation Manager Mobile App User Feedback	none	Anticoagulation Manager Mobile App User Survey
Applicability and Use of The Community Guide Among National Association of County and City Health Officials (NACCHO) Members	N/A	Applicability and Use of The Community Guide Among NACCHO Members (screenshots)
BioSense Platform User Satisfaction Survey
CDC Introduction to Informatics: Life of a Specimen and Life of a Result eLearning Courses Learner Feedback Survey	0920-0974	Learner Feedback Survey
CDC Public Health and Preparedness Webinar Feedback Survey	none	Learner Feedback Survey
Clinical Laboratory Interview Feedback on DLS Professional Development Service Offerings	n/q, n/a	Pre-interview Questionnaire ,   Interview Guide
Clinical laboratory focus group feedback on DLS professional development service offerings	none	Pre-Focus Group Questionnaire
Customer Service Feedback Survey of 2019 EIS Conference	none	2019 EIS Conference Survey
Diagnostic Parasitology Course Feedback	none	Diagnostic Parasitology Learner Feedback Survey
EIS and LLS Class of 2020 Applicant Customer Satisfaction Survey	0920-0974	CDC Fellowship Applicant Customer Satisfaction Survey
Evaluating the Applicability and Use of The Commmunity Guide among SAMHSA Grantees	none	SAMHSA Grantees Survey
Exposure to Arsenic and Uranium in Private Well Water in Connecticut New Mexico and New Hampshire	0920-1173, 0920-1173, 0920-1173	Screening Survey ,   Food and Bathing Log ,   Survey (Exposure to Arsenic an Uranium in Private Well Water in Connecticut, New Mexico, and New Hampshire
Feedback Survey of 2017 NSSP Annual Grantee Meeting	none	Survey of 2017 NSSP Grantee Meeting
Genomics and Population Health Action Collaborative (GPHAC) Interviews
Good Laboratory Practices for Biochemical Genetic Testing Preanalytic Phase eLearning Course Learner Feedback Survey
Good Laboratory Practices for Molecular Genetic Testing Learner Feedback Survey	0920-0974	2018 Public Health and Preparedness Webinar Learner Feedback Survey
Good Laboratory Practices for Molecular Genetic Testing eLearning Course Learner Feedback	0920-0974 (18AVD)	2018 Good Laboratory Practices for Molecular Genetic Testing Elearning Course Learner Feedback Survey
Implementing Public Health Genomics in Your State: Resources from CDC Office of Public Health	0920-17FC	Genomics Survey for Webinar 2016_11_18
Individualized Quality Control Plan Workbook Survey
Individualized Quality Control Plan Workbook Survey	0920-0974	03_Screen shots of IQCP Workbook Survey 01-19-2017
Laboratory Identification of Emerging Pathogenic Molds Course Learner Feedback Survey	0920-0974	Laboratory Identification of Emerging Pathogenic Molds Course Learner Feedback Survey
Laboratory Methods for Detecting Rabies Virus Course Learner Feedback Survey	0920-0974	Rabies Course Feedback Survey
Microbiology-Oriented eLearning Courses Learner Feedback Survey	0920-0974	Microbiology-Oriented eLearning Feedback
Mycobacterium tuberculosis: Diagnostic Principles and Procedures Course Learner Feedback Survey	0920-0974	Mtuberculosis Course Survey
Mycobacterium tuberculosis: Diagnostic Principles and Procedures Course Learner Feedback Survey	0920-0974	CDC 2019 Mycobacterium tuberculosis Diagnostic Principles and Procedures - Course Learner Feedback Survey
Packaging and Shipping Division 6.2 Materials eLearning Course Learner Feedback Survey	n/a	2018 Packaging and Shipping Division 6.2 Materials eLearning Course Feedback Survey
Public Health Laboratory Feedback on DLS Professional Development Service Offerings	none	Pre-focus group questionnaire
Public Health Laboratory Focus Group Feedback on DLS Professional Development Services Offerings	0920-0974, 0920-0974	Pre-Focus Group Questionnaire ,   Focus Group Guide
Public Health and Prepareness Webinars Learner Feedback Survey	0920-0974 (!!*ASY)	2018 Public Health and Preparedness Webinar Learner Feedback Survey

---

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	187,746	60,720	0	127,026	0	0
Annual Time Burden (Hours)	50,871	41,799	0	9,072	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: Request is being submitted to keep existing Generic Clearance on-going, although CIO submitted revision request with verbiage for additional burden and responses, it is not clear based on burden table reflected in SSA, 30 day doc based on hours requested. CIO will need to await further instruction from OMB desk officer as to whether another revision request will need to be submitted at a later time. CIO comments: "Additional burden hours are being requested primarily to reflect the increase in the number of Center programs due to a reorganization in 2014, use of electronic survey methods, and interest in customer input to and satisfaction with websites and products developed for constituents. Specifically, increases have resulted in association with use of electronic surveys, which allow for broader reach at lower survey costs, thus increasing number of surveys possible for a fixed budget."

---

Annual Cost to Federal Government: $393,149

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

---

Common Form ICR:  No

---

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: 06/15/2016

---