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
Form 0923-21IP Attachment 2a_Death Certification Word Survey	Form and Instruction	New	Repair queued
Form 0923-21IP Attachment 2_Death Certification Online Survey	Form and Instruction	New	Repair queued
Death Scene Investigation After Natural Disaster or Other Weather-Related Events	Form and Instruction	New	Repair queued
Recruitment	Form and Instruction	New	Repair queued
Recruitment Screener	Form and Instruction	New	Available
Form 0923-20KT 2020 CRSCI Recipients Meeting Evaluation (text)	Form	New	Available
Form 0923-0047 User Testing Script and Questionnaire	Form and Instruction	New	Available
CSPECE Resources Survey - text	Form	New	Available
CSPECE Resources Survey	Form	New	Available
Form 0923-0047 Traceable Opioid Material* Kit Questions	Form and Instruction	New	Available
Form 0923-0047 Wildfire Guide Assessement Interview	Form and Instruction	New	Available
Att4 RsrchDeterminationForm ATSDR 0923-0047 Extnsn 2018 signed OS.pdf	Supplementary Document	Uploaded 2018-11-26	Available
Att3 PIA_Request_0923-13BZ (OCN 0923-0047) signed OCISO BW.pdf	Supplementary Document	Uploaded 2018-11-26	Available
Att1 EO12862 - Authority.pdf	Supplementary Document	Uploaded 2018-11-26	Available
SSB_ATSDR 0923-0047 EXT.docx	Supporting Statement B	Uploaded 2018-11-26	Available
SSA_ATSDR 0923-0047_EXT.docx	Supporting Statement A	Uploaded 2018-11-26	Available
Att2 60dy180047.pdf	Supplementary Document	Uploaded 2018-11-26	Available
ATSDR 0923-0047 GnrcClrncQualFdbkTmpltapprvlFrm.docx	Supplementary Document	Uploaded 2018-11-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
249662	Survey on CDC NCEH Disaster-Related Death Certification Trainings	Form and Instruction	New	Attachment 2a_Death Certification Word Survey
249662	Survey on CDC NCEH Disaster-Related Death Certification Trainings	Form and Instruction	New	Attachment 2_Death Certification Online Survey
248976	Survey on CDC NCEH Death Scene Investigation after Natural Disasters or Other Weather-Related Events Toolkit Training	Other-WORD version of survey to facilitate review of content	New
248976	Survey on CDC NCEH Death Scene Investigation after Natural Disasters or Other Weather-Related Events Toolkit Training	Form and Instruction	New	Death Scene Investigation After Natural Disaster or Other Weather-Related Events
247650	Community Opinions on Communication Strategies and Tools about Cancer and Environmental Hazards	Other-Focus group guide	New
247650	Community Opinions on Communication Strategies and Tools about Cancer and Environmental Hazards	Form and Instruction	New	Recruitment
244555	Effective Communication for Water-related Emergencies and Disease Outbreaks	Other-Focus group guide	New
244555	Effective Communication for Water-related Emergencies and Disease Outbreaks	Form and Instruction	New	Recruitment Screener
240134	Post-Meeting Questionnaire of Attendees at the 2020 Climate Ready States and Cities Initiative (CRSCI) Recipients Meeting	Form	New	2020 CRSCI Recipients Meeting Evaluation (text)
240119	Usability Assessment of CRC SimPLER - Community Reception Center Simulation Program for Leveraging and Evaluating Resources	Form and Instruction	New	User Testing Script and Questionnaire
240062	CSPECE Resources Survey	Form	New	CSPECE Resources Survey - text
240062	CSPECE Resources Survey	Form	New	CSPECE Resources Survey
235913	Distribution of Traceable Opioid Material§ Kits across U.S. Laboratories	Form and Instruction	New	Traceable Opioid Material* Kit Questions
235905	Wildfire Guide Assessment Interview	Form and Instruction	New	Wildfire Guide Assessement Interview

ICR Details

OMB Control No: 0923-0047	ICR Reference No: 201810-0923-002
Status: Historical Active	Previous ICR Reference No: 201510-0923-001
Agency/Subagency: HHS/TSDR	Agency Tracking No: 19457
Title: 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: 01/30/2019
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/27/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2022	36 Months From Approved	02/28/2019
Responses	24,900	0	24,900
Time Burden (Hours)	21,225	0	21,225
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable the Agency 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 the Agency's 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:
	83 FR 8870	03/01/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 57488	11/15/2018
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 9

table that charts list of burden

IC Title	Form No.	Form Name
CSPECE Resources Survey	none, none	CSPECE Resources Survey ,   CSPECE Resources Survey - text
Community Opinions on Communication Strategies and Tools about Cancer and Environmental Hazards	none	Recruitment
Distribution of Traceable Opioid Material§ Kits across U.S. Laboratories	0923-0047	Traceable Opioid Material* Kit Questions
Effective Communication for Water-related Emergencies and Disease Outbreaks	none	Recruitment Screener
Post-Meeting Questionnaire of Attendees at the 2020 Climate Ready States and Cities Initiative (CRSCI) Recipients Meeting	0923-20KT	2020 CRSCI Recipients Meeting Evaluation (text)
Survey on CDC NCEH Death Scene Investigation after Natural Disasters or Other Weather-Related Events Toolkit Training	n/a	Death Scene Investigation After Natural Disaster or Other Weather-Related Events
Survey on CDC NCEH Disaster-Related Death Certification Trainings	0923-21IP, 0923-21IP	Attachment 2_Death Certification Online Survey ,   Attachment 2a_Death Certification Word Survey
Usability Assessment of CRC SimPLER - Community Reception Center Simulation Program for Leveraging and Evaluating Resources	0923-0047	User Testing Script and Questionnaire
Wildfire Guide Assessment Interview	0923-0047	Wildfire Guide Assessement Interview

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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	24,900	24,900	0	0	0	0
Annual Time Burden (Hours)	21,225	21,225	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: $500,000

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: 11/27/2018

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