Questionnaire for Soliciting Feedback on CPSC Regulatory Robot

Request for Approval Under the “Generic Clearance for the Collection
Qualitative Feedback on Agency Service Delivery” (OMB Control Number:
3041-0148)
TITLE OF INFORMATION COLLECTION:
Questionnaire for Soliciting Feedback on CPSC Regulatory Robot
PURPOSE:
To set up a permanent feedback mechanism for a new information product: the CPSC
Regulatory Robot (the “Robot”).
The Robot assists small businesses and individuals seeking guidance in identifying
regulations that apply to their consumer product(s). From input provided by the user, the
Robot produces a report with guidance that can be downloaded. After the Robot
completes the task (and once the report is downloaded), we propose including a link to a
voluntary feedback questionnaire that would be a permanent Web page, such as
www.cpsc.gov/robot/feedback. This page would not be a popup. CPSC is pursuing this
approval for feedback from the Robot’s relevant stakeholders/users. The feedback will
allow CPSC to adjust and correct the Robot, as needed. Seeking stakeholder/user input
aligns with the agency’s draft strategic goals, which include ensuring that stakeholders
receive useful information that will inform their decision making. The feedback
mechanism would assist CPSC staff in our efforts to ensure that the guidance information
is, in fact, “useful” to our stakeholders.
Our proposed questions are as follows:
Question 1: Based on your most recent experience, please rate the usefulness of the
Regulatory Robot? [Scale of 1-10 (1 = Not at all useful, 10 = Extremely useful]
Please tell us about your experience with the Regulatory Robot.
Question 2: What did we do well in designing the Regulatory Robot to meet your needs?
Question 3: What are your suggestions for how we can improve the Robot to meet your
needs?
Question 4: Which of the following best describes you or your organization? (Choose
one)
Manufacturer (Large)
Manufacturer (Mid-Size)
Manufacturer (Small)

Distributor

Government
(Domestic/Foreign)
Retailer
Association
(Trade/Consumer)
Attorney/Consultant Other ________

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Manufacturer
(Micro/Small Batch)

Testing Laboratory

Importer

Consumer

Example of Question 1 format from a for-profit website:

DESCRIPTION OF RESPONDENTS:
Respondents are individuals who will use the CPSC Regulatory Robot. They will be
asked at the end of the Robot to provide feedback on their experience and the usefulness
of the resource.
TYPE OF COLLECTION: (Check one)
[ ] Customer Comment Card/Complaint Form
[ ] Usability Testing (e.g., Website or Software
[] Focus Group

[X] Customer Satisfaction Survey
[ ] Small Discussion 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 noncontroversial 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 to substantially inform influential policy decisions.

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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: SHELBY MATHIS
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, is the information that will be collected included in records that are subject to the
Privacy Act of 1974? [ ] Yes [ ] No
3. If Applicable, has a System or 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
Category of Respondent

No. of
Participation
Respondents Time
500
4 minutes

Private Sector

Burden
33
hours

Totals
FEDERAL COST: The estimated annual cost to the federal government is = $ 1,694

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?
Individuals who use the Robot will be asked to submit their feedback. Only individuals
who complete the Robot such that a report is produced will be asked to respond to this
feedback questionnaire.
Administration of the Instrument
1. How will you collect the information? (Check all that apply)

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[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

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