Customer Feedback Fast Track Template

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number 0690-0030)

TITLE OF INFORMATION COLLECTION:
American Community Survey Customer Feedback Form

PURPOSE:

The Census Bureau’s American Community Survey Office is planning a survey to gather feedback from American Community Survey (ACS) users. This survey is designed to find out from ACS users whether they are looking for general information about participating in or responding to the ACS or they are looking for specific data, guidance, or documentation from the ACS.

One of the Census Bureau’s goals that cascade from the Department’s balanced scorecard is Customer Service Excellence. The ACS program monitors and values satisfactory customer service (ACS Objective 2.3) by evaluating customer’s experience with ACS website and data products released to the public. The feedback from this survey will help the ACS decide what improvements are needed in order to provide and deliver high quality, useful information to the nation and American people. One of the best ways to achieve this goal is to review customers’ experience with these different customer service channels and implement improvements.

This is new survey designed to capture new and existing customer satisfaction through customer feedback form with intend to measure respondent and/or end user’s satisfactory with the ACS website and its data products.

DESCRIPTION OF RESPONDENTS:

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [X] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus 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.

Name: Rebecca Vilky

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, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published?

[ ] Yes [ ] 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

Category of Respondent	No. of Respondents	Participation Time	Burden
Public	300 per year/4 years	3 mins	15
Totals	1200	3600	60

FEDERAL COST: The estimated annual cost to the Federal government is $0

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

The American Community Survey Customer Feedback will be hosted on the ACS website, available for all ACS visitors.

Everyone who wishes to provide feedback can use this survey. We do not have limit to the universe or sample size for this survey.

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?

Administration of the Instrument

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

Please submit all instruments, instructions, correspondences (emails, letters, etc.) to respondents, and scripts as separate documents along with this request document.

Every instrument must have the following displayed –

OMB Control No. 0690-0030

Expiration Date: 07/31/2020