Generic Clearance Submission

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 1910-5160)

T ITLE OF INFORMATION COLLECTION: Internal Communications Questionnaire to Gauge employee perceptions and attitudes around communications.

PURPOSE: To conduct a 30 day survey that may help ascertain effectiveness of a web-based policy information resource.

DESCRIPTION OF RESPONDENTS:

This survey is intended for DOE Federal employees and contractors, but will be viewable and subject to unintended responses from the general public since the PIR is on a public-facing system.

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: Carl Piechowski

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 You have to provide an estimate number of respondents and burden hours.

Category of Respondent	No. of Respondents	Participation Time	Burden (hours)
Individuals	50	5 minutes	4.2
Totals	50	5 minutes	4.2

FEDERAL COST: The estimated annual cost to the Federal government is $10,000.

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

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?

A memorandum is planned for issuance to program offices that are the target users of the web pages to notify them of the online survey and to provide them a copy of the survey questions. Survey responses are voluntary and not critical, so audience segmentation is not necessary.

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 make sure that all instruments, instructions, and scripts are submitted with the request.

Instructions for completing Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”

TITLE OF INFORMATION COLLECTION: Safeguards & Security (S&S) Policy Information Resource Survey Questions

PURPOSE: The survey will be used primarily to ascertain whether the S&S Policy Information Resource web page is providing useful information for its users.

DESCRIPTION OF RESPONDENTS: The targeted group of respondents consists of users that have or plan to use the application. This collection is intended for DOE federal employees and contractors. Members of the general public may be able to access and respond to the survey questions when visiting the web site. However, the general public is not the intended sample audience and its associated responses will likely be discarded.

TYPE OF COLLECTION: Survey questions with multiple choice or text responses.

CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.

Personally Identifiable Information: Provide answers to the questions. Note: Agencies should only collect PII to the extent necessary, and they should only retain PII for the period of time that is necessary to achieve a specific objective.

Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.

BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households;(2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be selected per row.

No. of Respondents: Provide an estimate of the Number of respondents.

Participation Time: Provide an estimate of the amount of time required for a respondent to participate (e.g. fill out a survey or participate in a focus group)

Burden: Provide the Annual burden hours: Multiply the Number of responses and the participation time and divide by 60.

FEDERAL COST: Provide an estimate of the annual cost to the Federal government.

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. Please provide a description of how you plan to identify your potential group of respondents and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.

Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.

Submit all instruments, instructions, and scripts are submitted with the request.

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