Nonimmigrant Visa

U.S. Department of State

REQUEST FOR APPROVAL UNDER THE "GENERIC CLEARANCE
FOR THE COLLECTION OF ROUTINE CUSTOMER FEEDBACK"
OMB CONTROL NUMBER: 1405-0193
Title of Information Collection

Consular Services: Nonimmigrant Visa Applicant Satisfaction Survey

Purpose

The Bureau of Consular Affairs (CA) desires to assess nonimmigrant visa applicant satisfaction with a number of operational issues
related to processing of nonimmigrant visas at approximately 200 consular sections overseas. Last year, CA adjudicated over II
million nonimmigrant visa applications. To achieve good customer service and make appropriate use of scarce resources, CA
would specifically appreciate feedback from nonimmigrant visa applicants on the quality of our visa information, the accessibility
of that information, the convenience of our appointment systems, and the professionalism of consular personnel.
CA intends to use software to aggregate survey responses to facilitate the identification and analysis of global trends as well as
provide each post the views of local respondents.

Description of Respondents

Respondents are foreign nationals who have applied for a nonimmigrant visa. Respondents may also be the parent or guardian of a
minor who is seeking a nonimmigrant visa.

Type of Collection: (Check one)

0
0
0

Customer Comment Card/Complaint Form
Usability Testing (e.g., Web site or Software)
Focus Group

[XI

Customer Satisfaction Survey

0
0

Other

Small Discussion Group

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 (Last, First, Ml)

Signer Email Address

I [email protected]
DS-4183
04-2015

Title

Date (mm-dd-yyyy)

09-I8-20 I5
Page 1 of 2

Personally Identifiable Information

1.

2.

0
a. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? 0
If Applicable, has a System of Records Notice been published?
0
Is personally identifiable information (PI/) collected?

Yes

[X)

Yes

0
0

Yes

[X)

Yes

No
No
No

Gifts or Payments

0

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants?

Category of Respondent

Individuals or Households

Totals

No

Number of Respondents

Participation Time (Minutes)

Burden Hours

30,000

5

2,500.00

30,000

5

2,500.00

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
No
selecting from this universe? [X) Yes

0

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.

In those areas, where nonimmigrant visa applicants are likely to have access to the internet, such applicants would be informed
by consular personnel during their visit to the visa unit of the uri or QR code for the survey. Applicants may thus take the
survey while waiting in the consular section, or they may do so later at their home or office.
Our greatest volume of nonimmigrant visa applicants reside in countries where internet access is widely available. Consular
personnel will encourage applicants to respond to the survey during the last quarter of CY 2015. CA will then assess the utility
of the methodology and consider how we might reach potential respondents who do not have reliable access to the internet in a
cost effective manner.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

lXI

Web-based or other forms of Social Media

0

Telephone

0
0
0

In-person
Mail
Other, Explain

2. Will interviewers or facilitators be used?

0

Yes

[X)

No

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Page 2 of 2

Return to Form
U.S. Department of State

REQUEST FOR APPROVAL UNDER THE "GENERIC CLEARANCE
FOR THE COLLECTION OF ROUTINE CUSTOMER FEEDBACK"
OMB CONTROL NUMBER: 1405-0193
INSTRUCTIONS
Title of Information Collection: Provide the name of the collection that is the subject of the request. (e.g., Comment card for soliciting feedback
on xxxx.)
Purpose: Provide a brief description of the purpose of this collection and how it will be used. If this is part of a larger study or effort, please include
this in your explanation.
Description of Respondents: Provide a brief description of the targeted group or groups for this collection of information. These groups must
have experience with the program.
Type of Collection: Check one box. If you are requesting approval of other instruments under the generic, you must complete a form for each
instrument.
Certification: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be
disapproved.
Personally Identifiable Information: Provide answers to the questions.
Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.
Burden Hours:
Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or
Households; (2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be
selected.
Number of Respondents: Provide an estimate of the number of respondents.
Participation Time: Provide an estimate of the amount of time required for a respondent to participate (e.g., fill out a survey or participate in
a focus group)
Burden: Provide the Annual burden hours: Multiply the Number of responses by the participation time, and then divide by 60.
Federal Cost: Provide an estimate of the annual cost to the Federal government.

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: Please provide a description of how you plan to identify your potential group of respondents
and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.
Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether
there will be interviewers (e.g., for surveys) or facilitators (e.g., for focus groups) used.
Please make sure that all instruments, instructions, and scripts are submitted with the request.

DS-4183
06-2011

Instruction Page 1 of 1