Collection of Qualitative Feedback on Agency Service Delivery

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CSOSA - 6 Electronic CJAN Participant Feedback Form	Form	New	Available
Form CSOSA - 3 Community Justice Advisory Network (CJAN) Meeting Participant Form	Form and Instruction	New	Repair queued
Form CSOSA - 1 Community Resource Day Program Participant Feedback Survey	Form and Instruction	New	Available
Form CSOSA - 4 MPD Partnership Training Session Survey	Form and Instruction	New	Available
Form CSOSA - 5 Community Service Program Participant Feedback Survey	Form and Instruction	New	Available
Form CSOSA - 2 Community Resource Day Program Presenter Feedback Survey	Form and Instruction	New	Available
OLIPA Generic Sample Surveys 2017.doc	Supplementary Document	Uploaded 2017-09-26	Available
OLIPA Generic Clearance Part A- Justification 6-2107.docx	Supporting Statement A	Uploaded 2017-08-01	Available
Generic Clearance Part B 032813 (3).doc	Supporting Statement B	Uploaded 2013-12-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
228474	OLIPA Survey Forms	Form	New	Electronic CJAN Participant Feedback Form
228474	OLIPA Survey Forms	Form and Instruction	New	Community Justice Advisory Network (CJAN) Meeting Participant Form
228474	OLIPA Survey Forms	Form and Instruction	New	Community Resource Day Program Participant Feedback Survey
228474	OLIPA Survey Forms	Form and Instruction	New	MPD Partnership Training Session Survey
228474	OLIPA Survey Forms	Form and Instruction	New	Community Service Program Participant Feedback Survey
228474	OLIPA Survey Forms	Form and Instruction	New	Community Resource Day Program Presenter Feedback Survey
215355	CJAN MEETING PARTICIPANT FEEDBACK FORM	Other-	Removed
215354	MPD PARTNERSHIP TRAINING SESSION SURVEY	Other-	Removed
215351	Community Resource Day - Presenter Form	Other-	Removed
215350	Community Resource Day - Program Participant Feedback Form	Other-	Removed

ICR Details

OMB Control No: 3225-0002	ICR Reference No: 201708-3225-001
Status: Historical Active	Previous ICR Reference No: 201312-3225-001
Agency/Subagency: CSOSA	Agency Tracking No: 07-181
Title: 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: 09/26/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/01/2017
Terms of Clearance:

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	450	0	1,340
Time Burden (Hours)	75	0	69
Cost Burden (Dollars)	0	0	0

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Abstract: The surveys collects qualitative customer and stakeholder feedback that will provide insights into customer or stakeholder perceptions, experiences and expectations, provide an early warning of issues with services, or focus attention on areas where communication, training or changes in operations might improve delivery of product or services.

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Authorizing Statute(s): PL: Pub.L. 105 - 33 1233 Name of Law: National Capital Revialization and Self-Government Improvement Act of 1997
  

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 84	05/03/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 32687	07/17/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
CJAN MEETING PARTICIPANT FEEDBACK FORM
Community Resource Day - Presenter Form
Community Resource Day - Program Participant Feedback Form
MPD PARTNERSHIP TRAINING SESSION SURVEY
OLIPA Survey Forms	CSOSA - 4, CSOSA - 1, CSOSA - 3, CSOSA - 6, CSOSA - 5, CSOSA - 2	Community Resource Day Program Presenter Feedback Survey ,   Community Service Program Participant Feedback Survey ,   MPD Partnership Training Session Survey ,   Community Resource Day Program Participant Feedback Survey ,   Community Justice Advisory Network (CJAN) Meeting Participant Form ,   Electronic CJAN Participant 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	450	1,340	0	-890	0	0
Annual Time Burden (Hours)	75	69	0	6	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: Agency giving respondents more time to complete surveys.

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Annual Cost to Federal Government: $19,160

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: 08/01/2017

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