Updated Generic Clearance Request Template

Status: Original and derived artifacts are available for this document.

Download: docx | pdf | html

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0651-0080)

TITLE OF INFORMATION COLLECTION:  G299: TC 3600 2019 Business Methods Partnership Meeting - Stakeholder Satisfaction Survey

PURPOSE:  This survey is to gather feedback from U.S. stakeholders regarding their satisfaction with topics discussed and the overall satisfaction level with attending the Business Methods Partnership meeting that will be held on April 2, 2019. 

DESCRIPTION OF RESPONDENTS: Respondents will be U.S. stakeholders who have attended the 2019 Business Methods Partnership meeting.

TYPE OF COLLECTION: (Check one or multiple)

[ ] 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.

Business Unit:  USPTO Technology Center 3600 – Business Methods

To assist review, please provide answers to the following question:

Personally Identifiable Information:
    1. Is personally identifiable information (PII) collected?  [  ] Yes  [X]  No 
1a.    If Yes, is the information that will be collected included in records that are subject to
        the Privacy Act of 1974?   [  ] Yes [  ] No   
    2. If applicable, has a System of Records Notice been published?  [  ] Yes  [  ] No  [X] N/A

Gifts or Payments:
Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants?  [  ] Yes [X] No  

	






BURDEN HOURS 

Name of Instrument
No. of Respondents
Participation Time
Burden
Survey
150
3 minutes
7.5 hours




Totals
150
- - -
7.5 hours

The USPTO estimates that 100% of the surveys will be conducted in person.

FEDERAL COST:  The estimated annual cost to the Federal government is average hourly rate of $71.69 per hour + 30% ($21.50) = $93.19 for a GS-15 step 3 for a total of 7.5 hours = $698.97

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?

The survey will be distributed to each registered person attending the Businesss Partnership meeting. 

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	
[X] In-person	
[ ] Mail 
[ ] Other, Explain: live poll software

    2. Will interviewers or facilitators be used?  [ ] Yes [ X] No