RD Customer Service Template

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0503-0021)

TITLE OF INFORMATION COLLECTION:

Customer Service Questionnaire

PURPOSE:

The “Customer Service Questionnaire” is part of Rural Development’s (RD) State Internal Review. The questionnaire is used to gather information to determine the quality of customer service provided by the RD staff.

The questionnaire consists of five main questions –

1. Rating the Rural Development’s staff on being prompt, friendly and knowledgeable.

2. Rating the quality of Rural Development’s response to your inquiries on being clear, accurate, consistent.

3. Rating the timeliness response to inquiries

4. Rating the Rural Development process on information being easy to obtain, forms are easy to use, and concerns raised were resolved.

5. General Comments

DESCRIPTION OF RESPONDENTS:

RD borrowers, organizations (trade associations) and contractors.

TYPE OF COLLECTION: (Check one)

[ ] 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.

Name: Janet Stouder, Compliance Specialist, Business Center, Internal Compliance Division

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, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Yes, has an up-to-date System of Records Notice (SORN) 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 Respondents	Participation Time	Burden
Borrowers, trade associations and contractors	4000	0.25 hrs.	1000 hrs.
Trade associations	250	0.25 hrs.	62.5 hrs.
Contractors	250	0.25 hrs.	62.5 hrs.
Totals	4500	0.25 hrs.	1125 hrs.

FEDERAL COST: The estimated annual cost to the Federal government is $45,000________

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? [X ] Yes [ ] 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?

RD’s state offices will be on a 3-year review cycle with one-third of the states reviewed annually. Selections will be based on RD’s state office providing a list of borrowers and organizations (trade associations) and contractors. Approximately twenty-five entities will be selected per program area for a total of 225 selections. Selections will be made using Microsoft Excel random selection function.

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

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

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