Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCHHSTP)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Site Visit Evaluation: Immediate Follow-up	Form and Instruction	New	Available
Web Assessment	Form	New	Available
Form 0920-1027 NPIN Evaluation Moderator Guide - Rank and File	Form and Instruction	New	Available
Form 0920-1027 NPIN Evaluation Moderator Guide - Managers	Form and Instruction	New	Available
Form 0920-1027 NPIN Evaluation Screener	Form and Instruction	New	Available
NPIN Survey - screenshots	Form	New	Available
NPIN Survey - word	Form	New	Available
NPIN Survey Screener	Form	New	Available
Form 0920-1027 Assessment of the Model Performance Evaluation Program (MPEP)	Form and Instruction	New	Available
Form 0920-1027 AAPCHO/MAYO Clinic Tuberculosis Assessment	Form and Instruction	New	Available
Screener	Form	New	Available
30dy FRN.pdf	Supplementary Document	Uploaded 2017-05-30	Available
Generic Clearance for Qualitative Feedback Template Approval Form.docx	Supplementary Document	Uploaded 2014-07-03	Available
SSB-NCHHSTP FastTrack .docx	Supporting Statement B	Uploaded 2017-05-30	Available
SSA-NCHHSTP FastTrack.docx	Supporting Statement A	Uploaded 2017-05-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
238972	Customer Service Satisfaction Assessment of TB Laboratory Site Visits conducted by CDC Laboratory Consultants-Online Survey	Form and Instruction	New	Site Visit Evaluation: Immediate Follow-up
238972	Customer Service Satisfaction Assessment of TB Laboratory Site Visits conducted by CDC Laboratory Consultants-Online Survey	Other-WORD version of instrument content to facilitate review of	New
235925	Customer Feedback from CDC-Funded CBO about Rapid Feedback Reports	Form	New	Web Assessment
231521	2018 NPIN Evaluation Focus Groups	Form and Instruction	New	NPIN Evaluation Moderator Guide - Rank and File
231521	2018 NPIN Evaluation Focus Groups	Form and Instruction	New	NPIN Evaluation Moderator Guide - Managers
231521	2018 NPIN Evaluation Focus Groups	Form and Instruction	New	NPIN Evaluation Screener
231322	2018 NPIN Web-based Survey	Form	New	NPIN Survey - screenshots
231322	2018 NPIN Web-based Survey	Form	New	NPIN Survey - word
231322	2018 NPIN Web-based Survey	Form	New	NPIN Survey Screener
230291	Assessment of the Model Performance Evaluation Program (MPEP)	Form and Instruction	New	Assessment of the Model Performance Evaluation Program (MPEP)
230291	Assessment of the Model Performance Evaluation Program (MPEP)	Other-WORD	New
229238	Assessment of Asian-American and Pacific Islanders Community Health Organizations' (AAPCHO) Providers Knowledge, Attitudes, and Practices Regarding Latent TB Infection	Form and Instruction	New	AAPCHO/MAYO Clinic Tuberculosis Assessment
228702	Virtual Focus Groups for Exploratory Research with Primary Care Physicians - Hepatitis C	Form	New	Screener
228702	Virtual Focus Groups for Exploratory Research with Primary Care Physicians - Hepatitis C	Other-Focus Group Guide	New

ICR Details

OMB Control No: 0920-1027	ICR Reference No: 201705-0920-017
Status: Historical Active	Previous ICR Reference No: 201407-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-14AMW
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCHHSTP)
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: 07/19/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/01/2017
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	07/31/2020	36 Months From Approved	08/31/2017
Responses	42,660	0	56,850
Time Burden (Hours)	29,070	0	37,200
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 continue to 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:
	82 FR 12966	03/08/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 24706	05/30/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
2018 NPIN Evaluation Focus Groups	0920-1027, 0920-1027, 0920-1027	NPIN Evaluation Screener ,   NPIN Evaluation Moderator Guide - Managers ,   NPIN Evaluation Moderator Guide - Rank and File
2018 NPIN Web-based Survey	none, none, none	NPIN Survey Screener ,   NPIN Survey - word ,   NPIN Survey - screenshots
Assessment of Asian-American and Pacific Islanders Community Health Organizations' (AAPCHO) Providers Knowledge, Attitudes, and Practices Regarding Latent TB Infection	0920-1027	AAPCHO/MAYO Clinic Tuberculosis Assessment
Assessment of the Model Performance Evaluation Program (MPEP)	0920-1027	Assessment of the Model Performance Evaluation Program (MPEP)
Customer Feedback from CDC-Funded CBO about Rapid Feedback Reports	none	Web Assessment
Customer Service Satisfaction Assessment of TB Laboratory Site Visits conducted by CDC Laboratory Consultants-Online Survey	n/a	Site Visit Evaluation: Immediate Follow-up
Virtual Focus Groups for Exploratory Research with Primary Care Physicians - Hepatitis C	none	Screener

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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	42,660	56,850	0	-14,190	0	0
Annual Time Burden (Hours)	29,070	37,200	0	-8,130	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Based on the number of burden hours actually used during the initial approval period and the number of respondents, we are requesting a decrease in the number of respondents (from 18,950 to 10,000) and burden hours (from 12,400 to 9,690).

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Annual Cost to Federal Government: $370,500

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: 06/01/2017

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