Generic Clearance Request Worksheet

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

TITLE OF INFORMATION COLLECTION: Certified Copy Center User Experience Satisfaction survey

PURPOSE: To obtain periodic user satisfaction information from customers of the USPTO Certified Copy Center. Feedback will be used to inform future design and functionality enhancements/improvements.

DESCRIPTION OF RESPONDENTS:

All users of the Certified Copy center are eligible to participate in the questionnaire.

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: OCIO_________/Michael Weiss/_ ___________________

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

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
Electronic customer satisfaction survey	~ 3600 (900 per quarter)	4 minutes	240 hours
Totals			240 hours

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

FEDERAL COST: $0

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?

All Certified Copy Center users are eligible to complete the questionnaire. The questionnaire will run for a 2 week period of time and there is no planned response limit. After the two weeks are done the questionnaire will be turned off. The plan is to repeat this process every quarter for a calendar year.

On average, the Certified Copy Center has approximately 6,000 users per two weeks. The questionnaire will only be presented to appromixately 15% of users. Therefore only approximately 900 users will have the opportunity to complete the questionnaire per quarter.

The electronic survey will be embedded within the Certified Copy Center application. The questionnaire tool being used will present a pop-up containing the questionnaire. The survey should not appear to until a user logs into the Certified Copy Center application.

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: live poll software

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

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