Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Forms and Documents

Document Name	Status
Form 0920-1050 Post visit survey for facility evaluation of US National Authority for Containment of Poliovirus (NAC) performance and improvement Form	New
Form PIDS User Feedback Customer Experience using the PRAMS Integrated Data Collection System Form and Instruction	New
Form 0920-1050 CDC Science Ambassador Virtual Training Series Survey Form and Instruction	New
Form 0920-21BA National Authority for Containment of Poliovirus 2020 Poliovirus Containment Webinar Participant Feedback Polling Questions and Survey Form and Instruction	New
NCIPC Website Usability Testing Form	New
Form 0920-1050 DELTA Reverse Site Visit Feedback Form and Instruction	New
Form 0920-1050 Website Usability Test for Division of Overdose Prevention Websites Form and Instruction	New
Form 0920-1050 Feedback web-survey on forensic toxicology testing Form and Instruction	New
Form 0920-20QM New Science Ambassador Virtual Training Series Survey Form and Instruction	New
Form 0920-20QB WISQARS Data Visualization Mapping Usability Testing Customer Feedback Form and Instruction	New
Form 0920-1050 Customer Feedback on CAMP Teen-SPARC Tool Use and Usability Form and Instruction	New
Form 0920-20OP Feedback on the use of the CDC Guideline for Prescribing Opioids for Chronic Pain. Form and Instruction	New
Form 0920-1050 Evaluators' Network, Member Survey Form	New
OCIO Customer Satisfaction Survey 2020 Form	New
Form 0920-20OI 2020 EIS Virtual Recruitment and Match Customer Service Survey Form and Instruction	New
Form 0920-1050 CDC Laboratory Courses for External Audiences Learner Feedback Survey Form and Instruction	New
Stakeholder Engagement and Feedback -Management of Acute and Chronic Pain Form and Instruction	New
Form 0920-1050 2020 Science Ambassador Application Survey Form and Instruction	New
Form 3 Month Follow up Pilot Survey of the Applying CDC's Guidelines for Prescribing Opioids Online Training and Updated Post Course Evaluation Form and Instruction	New
Form 0920-20IS 2020 Science Ambassador Regional Training Workshops Satisfaction Survey Form and Instruction	New
WISQARS Data Visualization Usability Testing Customer Feedback Form and Instruction	New
Form 0920-1050 Special Emphasis Panel (SEP) Peer Review Evaluation for Quality Improvement Form and Instruction	New
Form 0920-20DJ CDC Laboratory Identification of Emerging Pathogenic Molds Course Learner Feedback Survey Form and Instruction	New
CDC Basic Molecular Biology eLearning Courses Learner Feedback Survey Form and Instruction	New
Form 0920-1050 Fundamentals of Working Safely in a Biological Safety Cabinet, Fundamentals of Chemical Fume Hood Safety, and Fundamentals of Centrifuge Safety CDC eLearning Courses Learner Feedback Survey Form and Instruction	New
Form 0920-1050 CDC Packaging and Shipping Division 6.2 Materials eLearning Course Learner Feedback Survey Form and Instruction	New
CDC Microbiology-Oriented eLearning Courses Learner Feedback Survey Form	New
CDC Import Permit Program (IPP) Inspection Feedback Survey Form and Instruction	New
CDC-INFO IVR Satisfaction Survey (for Individual Respondents Who Inquire by Phone) Form and Instruction	New
CDC INFO Email Survey [ALT title: CDC-INFO Web-based Satisfaction Survey (for Individual Respondents Who Send Email Inquiries)] Form and Instruction	New
CDC-INFO IVR Satisfaction Survey (for Private Sector Respondents Who Inquire by Phone) Form and Instruction	New
CDC-INFO Web-based Satisfaction Survey (for Private Sector Respondents Who Send Email Inquiries) Form and Instruction	New
Assessment of National Public Health Institutes'(NPHI) Capacity to Strengthen Essential Public Health Functions in Countries Supported by U.S. Centers for Disease Control and Prevention Form and Instruction	New
Education and Training Services Branch Customer Satisfaction Survey Form	New
Form 0920-1050 Preparedness Field Assignee Alumni Survey Form and Instruction	New
Form 0920-1050 Public Health Improvement Training (PHIT) Reaction Survey Form and Instruction	New
An Assessment of the Feasibility and Sustainability of CDC Zika Activities Funded Under the USAID/CDC Interagency Agreement Form and Instruction	New
Form 0920-1050 App and Web Usability Study for CDC's STD Treatment Guidelines Form and Instruction	New
Customer Service GenIC Clearance Template (Final 5.3).docx Supplementary Document	2019-05-03
2018-05915.pdf Supplementary Document	2019-02-28
SSB fast track revision.docx Supporting Statement B	2019-02-28
SSA fast track revision.docx Supporting Statement A	2019-02-28

IC Document Collections

IC ID	Document Title	Status
244975	Post visit survey for facility evaluation of US National Authority for Containment of Poliovirus (NAC) performance and improvement Form	New
244970	Customer Experience using the PRAMS Integrated Data Collection System Form and Instruction	New
244599	CDC Science Ambassador Virtual Training Series Survey Form and Instruction	New
244553	National Authority for Containment of Poliovirus 2020 Poliovirus Containment Webinar Participant Feedback Polling Questions and Survey Form and Instruction	New
243814	NCIPC Website Usability Testing Form	New
243166	DELTA Reverse Site Visit Feedback Form and Instruction	New
243165	Feedback interviews to improve technical assistance Other-WORD	New
243063	Website Usability Test for Division of Overdose Prevention Websites Form and Instruction	New
243039	Feedback web-survey on forensic toxicology testing Form and Instruction	New
242695	New Science Ambassador Virtual Training Series Survey Form and Instruction	New
242578	WISQARS Data Visualization Mapping Usability Testing Customer Feedback Form and Instruction	New
242515	Violence Prevention Technical Assistance Center: Needs Assess Other-WORD	New
242280	Customer Feedback on CAMP Teen-SPARC Tool Use and Usability Form and Instruction	New
241950	Feedback on the use of the CDC Guideline for Prescribing Opioids for Chronic Pain. Form and Instruction	New
241912	Evaluators' Network, Member Survey Form	New
241897	OCIO Customer Satisfaction Survey 2020 Form	New
241850	2020 EIS Virtual Recruitment and Match Customer Service Survey Form and Instruction	New
241598	Assessing Perceptions of Operational Planning Workshops to Facilitate Country Planning for Increasing Health Security Capacities Instruction	New
241346	Customer Feedback for Raising Healthy Boys Other-WORD	New
241329	CDC Laboratory Courses for External Audiences Learner Feedback Survey Form and Instruction	New
240802	Stakeholder Engagement and Feedback -Management of Acute and Chronic Pain Form and Instruction	New
240546	2020 Science Ambassador Application Survey Form and Instruction	New
240503	Stakeholder Engagement and Feedback -Management of Acute and Chronic Pain Instruction	New
240490	Pilot Survey of the Applying CDC's Guidelines for Prescribing Opioids Online Training and Updated Post Course Evaluation Form and Instruction	New
240124	Stakeholder Engagement and Feedback -Management of Acute and Chronic Pain Other-WORD	New
240004	Raising Healthy Boys: Communications Toolkit Other-WORD	New
239964	2020 Science Ambassador Regional Training Workshops Satisfaction Survey Form and Instruction	New
239612	WISQARS Data Visualization Usability Testing Customer Feedback Form and Instruction	New
239565	Dating Matters Customer Satisfaction Survey Instruction	New
239278	Veto Violence Evaluation Y2 Other-WORD	New
239208	Special Emphasis Panel (SEP) Peer Review Evaluation for Quality Improvement Form and Instruction	New
238726	CDC Laboratory Identification of Emerging Pathogenic Molds Course Learner Feedback Survey Form and Instruction	New
238459	CDC Basic Molecular Biology eLearning Courses Learner Feedback Survey Form and Instruction	New
238101	Fundamentals of Working Safely in a Biological Safety Cabinet, Fundamentals of Chemical Fume Hood Safety, and Fundamentals of Centrifuge Safety CDC eLearning Courses Learner Feedback Survey Form and Instruction	New
237782	CDC Packaging and Shipping Division 6.2 Materials eLearning Course Learner Feedback Survey Form and Instruction	New
237522	CDC Microbiology-Oriented eLearning Courses Learner Feedback Survey Form	New
237144	CDC Import Permit Program (IPP) Inspection Feedback Survey Form and Instruction	New
237123	CDC-INFO IVR Satisfaction Survey (for Individual Respondents Who Inquire by Phone) Form and Instruction	New
236806	CDC INFO Email Survey [ALT title: CDC-INFO Web-based Satisfaction Survey (for Individual Respondents Who Send Email Inquiries)] Form and Instruction	New
236805	CDC-INFO IVR Satisfaction Survey (for Private Sector Respondents Who Inquire by Phone) Form and Instruction	New
236803	CDC-INFO Web-based Satisfaction Survey (for Private Sector Respondents Who Send Email Inquiries) Form and Instruction	New
236453	Public Health Improvement Training Reaction Survey Other-WORD	New
236431	Assessment of National Public Health Institutes'(NPHI) Capacity to Strengthen Essential Public Health Functions in Countries Supported by U.S. Centers for Disease Control and Prevention Form and Instruction	New
236378	Education and Training Services Branch Customer Satisfaction Survey Form	New
236303	Preparedness Field Assignee Alumni Survey Form and Instruction	New
236201	Public Health Improvement Training (PHIT) Reaction Survey Form and Instruction	New
236179	An Assessment of the Feasibility and Sustainability of CDC Zika Activities Funded Under the USAID/CDC Interagency Agreement Form and Instruction	New
236016	App and Web Usability Study for CDC's STD Treatment Guidelines Form and Instruction	New

ICR Details

OMB Control No: 0920-1050	ICR Reference No: 201902-0920-022
Status: Active	Previous ICR Reference No: 201605-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1050
Title: Generic Clearance for the 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 with change	Conclusion Date: 05/06/2019
	Date Received in OIRA: 03/21/2019
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2022	36 Months From Approved	06/30/2019
Responses	216,000	0	206,400
Time Burden (Hours)	66,750	0	60,750
Cost Burden (Dollars)	0	0	0

---

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. Revision request to add respondents and burden.

---

Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 12766	03/23/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 10093	03/19/2019
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 48

IC Title	Form No.	Form Name
Preparedness Field Assignee Alumni Survey	0920-1050	Preparedness Field Assignee Alumni Survey
Assessing Perceptions of Operational Planning Workshops to Facilitate Country Planning for Increasing Health Security Capacities
Public Health Improvement Training Reaction Survey	0920-1050, 0920-1050	NNPHI (Public Health Improvement Training Reaction Survey) ,   NNPHI (PHIT End of Training Survey)
Assessment of National Public Health Institutes'(NPHI) Capacity to Strengthen Essential Public Health Functions in Countries Supported by U.S. Centers for Disease Control and Prevention	N/A	Interview Protocol - Assessment of NPHI Capacity
CDC Laboratory Courses for External Audiences Learner Feedback Survey	0920-1050	2020 CDC Laboratory Courses for External Audiences Learner Feedback Survey
Education and Training Services Branch Customer Satisfaction Survey	none	ETSB Customer Satisfaction Survey
App and Web Usability Study for CDC's STD Treatment Guidelines	0920-1050	User Testing Questions for STD Tx Guide Mobile App and Website
CDC-INFO IVR Satisfaction Survey (for Private Sector Respondents Who Inquire by Phone)	n/a, n/a	Survey (English language) ,   Survey (Spanish language)
WISQARS Data Visualization Usability Testing Customer Feedback	n/a	WISQARS User Survey
DELTA Reverse Site Visit Feedback	0920-1050	2020 Reverse Site Visit Feedback Form
Customer Experience using the PRAMS Integrated Data Collection System	PIDS User Feedback	0920-21BX
2020 Science Ambassador Application Survey	0920-1050	2020 Science Ambassador Application Survey
Stakeholder Engagement and Feedback -Management of Acute and Chronic Pain	none	Stakehold Engagement
National Authority for Containment of Poliovirus 2020 Poliovirus Containment Webinar Participant Feedback Polling Questions and Survey	0920-21BA	US NAC Webinar Polling Questions
CDC Science Ambassador Virtual Training Series Survey	0920-1050, 09201050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050	Respondents - No Attendance Session Scheduling (Fall) ,   Respondents - No Attendance Session Scheduling (Spring) ,   CDC Science Ambassador Virtual Training Series Satisfaction Survey (1 survey) ,   Training Effectiveness Follow-up (Fall) OR Training Effectiveness Follow-up (Spring) ,   CDC Science Ambassador Virtual Training Series Satisfaction Survey (2 surveys) ,   Training Effectiveness Follow-up (Fall) ,   Training Effectiveness Follow-up (Spring) ,   CDC Science Ambassador Virtual Training Series Satisfaction Survey (3 surveys) ,   Training Effectiveness Follow-up (Fall) ,   Training Effectiveness Follow-up (Spring) ,   CDC Science Ambassador Virtual Training Series Satisfaction Survey (4 surveys) ,   Training Effectiveness Follow-up (Fall) ,   Training Effectiveness Follow-up (Spring) ,   CDC Science Ambassador Virtual Training Series Satisfaction Survey (5 surveys) ,   Training Effectiveness Follow-up (Fall) ,   Training Effectiveness Follow-up (Spring)
Stakeholder Engagement and Feedback -Management of Acute and Chronic Pain
Dating Matters Customer Satisfaction Survey	0920-1050, 0920-1050	Online Survey - Interview Guide ,   Remote Interview Guide
An Assessment of the Feasibility and Sustainability of CDC Zika Activities Funded Under the USAID/CDC Interagency Agreement	n/a	Interview guide exploring crosscutting areas associated with sustainability
CDC INFO Email Survey [ALT title: CDC-INFO Web-based Satisfaction Survey (for Individual Respondents Who Send Email Inquiries)]	n/a, n/a	Survey (Spanish) ,   Survey (English language)
Public Health Improvement Training (PHIT) Reaction Survey	0920-1050, 0920-1050	PHIT End of Session Survey - Web version ,   PHIT End of Training Survey - Web version
2020 EIS Virtual Recruitment and Match Customer Service Survey	0920-20OI	2020 EIS Virtual Recruitment and Match Customer Service Survey
Fundamentals of Working Safely in a Biological Safety Cabinet, Fundamentals of Chemical Fume Hood Safety, and Fundamentals of Centrifuge Safety CDC eLearning Courses Learner Feedback Survey	0920-1050	BSC / CFH / Centrifuge Learner Survey
Special Emphasis Panel (SEP) Peer Review Evaluation for Quality Improvement	0920-1050	Peer Reviewers Evaluation Form
Stakeholder Engagement and Feedback -Management of Acute and Chronic Pain
2020 Science Ambassador Regional Training Workshops Satisfaction Survey	0920-20IS	2020 Science Ambassador Regional Training Workshop Satisfaction Survey
Customer Feedback for Raising Healthy Boys	0920-1050	Participant Screening Form
Website Usability Test for Division of Overdose Prevention Websites	0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050	Individual - Rx Awareness Moderator Guide ,   Individual - Marijuana Moderator Guide ,   Healthcare Provider Screener ,   Healthcare Provider - Drug Overdose Moderator Guide ,   Healthcare Provider - Acute Pain Moderator Guide ,   Individual Screener
Post visit survey for facility evaluation of US National Authority for Containment of Poliovirus (NAC) performance and improvement	0920-1050	Post Site Visit Survey
CDC Basic Molecular Biology eLearning Courses Learner Feedback Survey	n/a	CDC Basic Molecular Biology eLearning Courses Learner Feedback Survey
Veto Violence Evaluation Y2	0920-1050, 0920-1050	Violence Prevention in Practice ,   Connection Selector Survey
CDC Packaging and Shipping Division 6.2 Materials eLearning Course Learner Feedback Survey	0920-1050	Customer Survey
WISQARS Data Visualization Mapping Usability Testing Customer Feedback	0920-20QB, 0920-20QB	Participant_Screener ,   Usability_Testing_Discussion_Guide
Feedback on the use of the CDC Guideline for Prescribing Opioids for Chronic Pain.	0920-20OP	Online Feedback Opioid Guides
Feedback interviews to improve technical assistance
NCIPC Website Usability Testing	none, none	Usability Testing Instrument ,   Screenshots
CDC-INFO Web-based Satisfaction Survey (for Private Sector Respondents Who Send Email Inquiries)	n/a, n/a	Survey (English language) ,   Survey (Spanish language)
OCIO Customer Satisfaction Survey 2020	none	Customer Satisfaction Survey 2020
Violence Prevention Technical Assistance Center: Needs Assess
Customer Feedback on CAMP Teen-SPARC Tool Use and Usability	0920-1050	SPARC Survey
Evaluators' Network, Member Survey	0920-1050	2020 Annual Evaluators' Network Member Survey
New Science Ambassador Virtual Training Series Survey	0920-20QM	2020 Science Ambassador Virtual Training Series Satisfaction Survey
CDC-INFO IVR Satisfaction Survey (for Individual Respondents Who Inquire by Phone)	n/a, n/a	Interactive Voice Response Survey (English language) ,   Interactive Voice Response Survey (Spanish language)
CDC Laboratory Identification of Emerging Pathogenic Molds Course Learner Feedback Survey	0920-20DJ	920-20DJ
Raising Healthy Boys: Communications Toolkit
Feedback web-survey on forensic toxicology testing	0920-1050	Customer Feedback Forensic Toxicology
Pilot Survey of the Applying CDC's Guidelines for Prescribing Opioids Online Training and Updated Post Course Evaluation	3 Month Follow up Survey	0920-20LD
CDC Import Permit Program (IPP) Inspection Feedback Survey	n/a	CDC Import Permit Program (IPP) Inspection Feedback Survey
CDC Microbiology-Oriented eLearning Courses Learner Feedback Survey	none	eLearning Course Feedback Survey

---

ICR Summary 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	216,000	206,400	0	9,600	0	0
Annual Time Burden (Hours)	66,750	60,750	0	6,000	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: Burden increase due to anticipation of consolidating other Agency Service Delivery clearances into this generic collection.

---

Annual Cost to Federal Government: $55,000

Does this IC contain surveys, censuses, or employ statistical methods? No

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

---

Common Form ICR:  No

---

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: 03/21/2019

---