Fast Track 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
30-day Federal Register, Volume 82 Issue 142 (Wednesday, July 26, 2017).htm	Supplementary Document	Uploaded 2017-08-10	Available
60-day Federal Register, Volume 82 Issue 87 (Monday, May 8, 2017).htm	Supplementary Document	Uploaded 2017-08-10	Available
0990-0379 Change Request_DKC.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2015-03-03	Available
0990-0379_B.docx	Supporting Statement B	Uploaded 2014-07-02	Available
0990-0379_FastTrack Generic SS A_8_11-2017.docx	Supporting Statement A	Uploaded 2017-08-11	Available
Generic Clearance Submission Template.docx	Supplementary Document	Uploaded 2011-06-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
242385	Bureau of Health Workforce (BHW) Website Card Sort	Instruction	New
241935	HealthIT.gov Website Satisfaction Survey	Other-survey	New
241507	Office of Population Affairs (OPA) Title X Grantee Needs Assessment Survey	Other-needs assessment survey with scripts and instructions	New
241442	Office of Population Affairs Teen Pregnancy Prevention and Pregnancy Assistance Fund Grantee Satisfaction Survey	Other-survey and scripts	New
240556	HRSA Web Survey for Bureau of Health Workforce (BHW) program participants	Other-Survey	New
238901	OWHPA Grantee Cross-Site Evaluation	Other-Survey Instrument- Grantee	New
238886	Office on Women's Health Youth Engagement in Sports (YES) Initiative Online Survey	Other-YES Initiative Survey Instrument	New
238645	ASPR TRACIE Webinar Polling	Other-Polling Consent Guide	New
238640	HRSA In-Page Web Survey	Other-survey	New
237566	Feedback onTopics of Interest for the Provision of technical assistance for Teen Pregnancy Prevention Program Grantees in FY2019	Other-survey and instruction	New
236685	STEP Post Survey	Other-survey	New
236682	STEP Pre Survey	Other-survey	New
236677	Youth Listening Session Grantee Satisfaction Survey 2019	Other-survey and instructions	New
236563	Peer Support and Pain Self-Management Education Program Feedback	Other-evaluation	New
235921	Office of Adolescent Health Individual Technical Assistance Grantee Satisfaction Surveys	Other-survey and instructions	New
235917	Office of Adolescent Health Grantee Group Training and Technical Assistance Satisfaction Survey	Other-survey and script	New
235834	Office of Adolescent Health Annual Grantee Satisfaction Survey	Other-survey with instructions	New
235787	HRSA Bureau of Health Workforce (BHW) Site Admin Portal Satisfaction Survey	Other-survey	New
235786	HRSA Health Workforce Connector (HWC) Satisfaction Survey	Other-survey	New
235506	OWH Prevention Award - Provider Qualitative Interviews	Other-Interview	New
235505	OWH Prevention Award - SBIRT Provider Knowledge and Confidence Survey	Other-Survey	New
234828	Request for feedback from Teen Pregnancy Prevention Program (TPP) Grantees on the technical assistance (TA) and training provided to them by the Office of Adolescent Health (OAH)	Other-survey	New
234739	Home Health and Hospice Survey and Interviews	Other-survey	New
233963	Womenshealth.gov Homepage Redesign Testing	Other-Screener	New
232651	Surveys for Building Your Wellness Toolbox (A six week psycho-educational group as part of the Promoting Older Women's Engagement in Recovery project)	Other-survey	New
232582	www.medicalcountermeasures.gov customer site feedback form	Other-questionnaire	New
232576	Rowan University School of Osteopathic Medicine (SOM)	Other-PRE Assessment	New
231850	Promoting Older Women's Engagement in Recovery (POWER) Post Training Surveys	Other-training survey	New
231844	Azalea Prevention Project	Other-follow-up survey	New
231775	Comments on the Cybersecurity in the healthcare and public health sector	Other-forms	New
231392	Qualitative Research for Medical Community Baselining Phase II	Other-guide	New
231189	PHE.gov Satisfaction Surveys: Exit Survey and In-Page Survey	Other-survey	New
230876	Card Sort Online Data Collection for Grants.gov	Other-survey	New
230875	Tree Testing for Grants.Gov	Other-survey	New
230865	Surveys to Inform Service Delivery Improvement of Teen Intervene Curriculum with Mental Health Providers and Adolescent Clients	Other-survey	New
230637	Join the Healthcare and Public Health (HPH) Risk Identification and Site Criticality (RISC) Toolkit Mailing List	Other-survey	New
229868	ODPHP Website Visitor Satisfaction Site- and Page-Level Surveys	Other-questionnaire	New
229756	Health and Human Services (HHS) Office of the Assistant Secretary for Health (OASH) Region 4, Raising Awareness of Human Trafficking Among School Personnel Training End-of-Course Evaluation	Other-survey	New
229755	Adolescent SBIRT (A-SBIRT) In-Person Training Feedback Surveys: a) Satisfaction and Retrospective Knowledge and Awareness Survey b) A-SBIRT 3 month/6 month Usage Feedback Survey(s)	Other-survey	New
229754	Adolescent SBIRT (A-SBIRT) Online Training (Kognito) Feedback Surveys	Other-follow up survey	New
229536	Promoting Older Women's Engagement in Recovery (POWER) Seeking Safety Training Survey	Other-survey	New
229535	Promoting Older Women's Engagement in Recovery (POWER) Post Training Survey	Other-trainiing	New
228940	Tree Testing FDA.Gov	Other-survey	New
228504	Region IX Office of the Regional Health Administrator (ORHA) External Customer Satisfaction Survey	Other-survey	New
228490	FDA.gov Card Sort Online Survey	Other-form	New
228489	Health IT Website Satisfaction Survey	Other-form	New

ICR Details

OMB Control No: 0990-0379	ICR Reference No: 201708-0990-001
Status: Historical Active	Previous ICR Reference No: 201503-0990-001
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/25/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/11/2017
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	09/30/2020	36 Months From Approved	09/30/2017
Responses	3,000,000	0	3,000,000
Time Burden (Hours)	500,000	0	500,000
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable HHS 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 HHS 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 21392	05/08/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 34682	07/26/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 46

table that charts list of burden

IC Title	Form No.	Form Name
ASPR TRACIE Webinar Polling
Adolescent SBIRT (A-SBIRT) In-Person Training Feedback Surveys: a) Satisfaction and Retrospective Knowledge and Awareness Survey b) A-SBIRT 3 month/6 month Usage Feedback Survey(s)
Adolescent SBIRT (A-SBIRT) Online Training (Kognito) Feedback Surveys
Azalea Prevention Project
Bureau of Health Workforce (BHW) Website Card Sort
Card Sort Online Data Collection for Grants.gov
Comments on the Cybersecurity in the healthcare and public health sector
FDA.gov Card Sort Online Survey
Feedback onTopics of Interest for the Provision of technical assistance for Teen Pregnancy Prevention Program Grantees in FY2019
HRSA Bureau of Health Workforce (BHW) Site Admin Portal Satisfaction Survey
HRSA Health Workforce Connector (HWC) Satisfaction Survey
HRSA In-Page Web Survey
HRSA Web Survey for Bureau of Health Workforce (BHW) program participants
Health IT Website Satisfaction Survey
Health and Human Services (HHS) Office of the Assistant Secretary for Health (OASH) Region 4, Raising Awareness of Human Trafficking Among School Personnel Training End-of-Course Evaluation
HealthIT.gov Website Satisfaction Survey
Home Health and Hospice Survey and Interviews
Join the Healthcare and Public Health (HPH) Risk Identification and Site Criticality (RISC) Toolkit Mailing List
ODPHP Website Visitor Satisfaction Site- and Page-Level Surveys
OWH Prevention Award - Provider Qualitative Interviews
OWH Prevention Award - SBIRT Provider Knowledge and Confidence Survey
OWHPA Grantee Cross-Site Evaluation
Office of Adolescent Health Annual Grantee Satisfaction Survey
Office of Adolescent Health Grantee Group Training and Technical Assistance Satisfaction Survey
Office of Adolescent Health Individual Technical Assistance Grantee Satisfaction Surveys
Office of Population Affairs (OPA) Title X Grantee Needs Assessment Survey
Office of Population Affairs Teen Pregnancy Prevention and Pregnancy Assistance Fund Grantee Satisfaction Survey
Office on Women's Health Youth Engagement in Sports (YES) Initiative Online Survey
PHE.gov Satisfaction Surveys: Exit Survey and In-Page Survey
Peer Support and Pain Self-Management Education Program Feedback
Promoting Older Women's Engagement in Recovery (POWER) Post Training Survey
Promoting Older Women's Engagement in Recovery (POWER) Post Training Surveys
Promoting Older Women's Engagement in Recovery (POWER) Seeking Safety Training Survey
Qualitative Research for Medical Community Baselining Phase II
Region IX Office of the Regional Health Administrator (ORHA) External Customer Satisfaction Survey
Request for feedback from Teen Pregnancy Prevention Program (TPP) Grantees on the technical assistance (TA) and training provided to them by the Office of Adolescent Health (OAH)
Rowan University School of Osteopathic Medicine (SOM)
STEP Post Survey
STEP Pre Survey
Surveys for Building Your Wellness Toolbox (A six week psycho-educational group as part of the Promoting Older Women's Engagement in Recovery project)
Surveys to Inform Service Delivery Improvement of Teen Intervene Curriculum with Mental Health Providers and Adolescent Clients
Tree Testing FDA.Gov
Tree Testing for Grants.Gov
Womenshealth.gov Homepage Redesign Testing
Youth Listening Session Grantee Satisfaction Survey 2019
www.medicalcountermeasures.gov customer site feedback form

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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	3,000,000	3,000,000	0	0	0	0
Annual Time Burden (Hours)	500,000	500,000	0	0	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $250,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 08/11/2017

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