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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 6000-026 Crisfield 6-month Post-Academy Interview Protocol	Form and Instruction	New	Repair queued
Form 6000-025 Crisfield Resilience Academy Session Evaluation	Form	New	Repair queued
Form 6000-024 CRISFIELD RESILIENCE ACADEMY: POST-SURVEY QUESTIONS	Form	New	Repair queued
Form 6000-023 CRISFIELD RESILIENCE ACADEMY: PRE-SURVEY QUESTIONS	Form	New	Repair queued
Form 6700-035 Healthy Homes Assessment and Energy Audit Feedback	Form	New	Repair queued
Form 6700-034 Healthy Homes and ECO Neighborhoods Survey	Form	New	Repair queued
Form 6200-030 Minimizing Displacement Resulting from Brownfields Assessment, Cleanup and Reuse	Form	New	Repair queued
Form 6200-031 Technical Assistance to Brownfield Communities – Evaluation Questions	Form	New	Repair queued
Form 6200-035 Land Revitalization Technical Assistance to Brownfields Communities (LRTA) – Evaluation Questions	Form	New	Repair queued
Form 6200-033 Groundwork USA Nonprofit Technical Assistance Grant Customer Satisfaction Survey	Form	New	Repair queued
Form HIA Training Feedb 6700-082	Form and Instruction	New	Repair queued
Form 5800-095 Feedback Survey: Northwest Environmental Justice Center Launch Event	Form	New	Repair queued
Form 6000-030 Equitable Resilience Builder Tool Feedback Survey	Form	New	Repair queued
Form 6700-031 Climate & Sustainability Event Survey	Form	New	Repair queued
Form 6700-030 Climate Champion Final Reflection	Form and Instruction	New	Repair queued
Form 6700-029 Climate Champion Monthly Reflection	Form and Instruction	New	Repair queued
Form 6700-023 Post-Assessment of CHAs-in-Training	Form	New	Repair queued
Form 6700-022 Pre-Assessment of CHAs-in-Training	Form	New	Repair queued
Form 6700-021 CHA Behavior Survey	Form	New	Repair queued
Form 6700-020 Fishers Workshop Pledges (Multiple languages)	Form	New	Repair queued
Form 6700-019 Fishers Workshop POST-Survey (Multiple Languages)	Form	New	Repair queued
Form 6700-018 Fishers Workshop PRE-Survey (Multiple Languages)	Form	New	Repair queued
Form 6700-017 Moms and Caregivers Background Survey (Multiple Languages)	Form	New	Repair queued
Form 6700-016 Moms and Caregivers Mini Quiz (Multiple Languages)	Form	New	Repair queued
Form 6700-015 Moms and Caregivers Pledges (Multiple Languages)	Form	New	Repair queued
Form 6700-014 Moms and Caregivers Self-Assessment (Multiple Languages)	Form	New	Repair queued
Form 6700-013 Public Health Seattle & King County EPA Outreach Event Survey	Form	New	Repair queued
Form 6700-028 Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline 2nd Survey	Form	New	Repair queued
Form 6700-027 Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline 1st Survey	Form	New	Repair queued
Form 5800-094 OEJECR EJ Grantee Post-Orientation Feedback Survey	Form	New	Repair queued
Form 6700-025 LISS Partnership DEI/EJ Survey	Form	New	Repair queued
Form 6700-011 Impact Analysis Questions for Communities	Form	New	Repair queued
Form 6700-024 NE West Plains PFAS Drinking Water Sampling Interest Questions	Form and Instruction	New	Repair queued
Form 5800-090 Community, Equity and Resiliency (CER) Regional Roadshow Events Survey	Form	New	Repair queued
Form 5800-093 EJ TCTAC Intake Form Center C	Form	New	Repair queued
Form 5800-092 EJ TCTAC Intake Form Center B	Form	New	Repair queued
Form 5800-091 EJ TCTAC Intake Form Center A	Form	New	Repair queued
Form 9600-056 Customer Satisfaction Survey: Pesticide Safety Education Funds Management Program	Form	New	Repair queued
Form 5800-089 Environmental and Climate Justice Community Change Technical Assistance Request Form	Form	New	Repair queued
Form 5800-088 Equitable Resilience Technical Assistance for Community Change Grants - Request Form	Form	New	Repair queued
Form 6000-027 Evaluation Survey: EPA Annual Drinking Water Workshop: Small System Challenges and Solutions	Form	New	Repair queued
Form 6700-912 Gulf of Mexico Division Funding Opportunities	Form	New	Repair queued
Form 5800-087 Customer Service Questions for Smart Growth Network Quarterly Discussion	Form	New	Repair queued
Form 6100-081 Screener - Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations	Form and Instruction	New	Repair queued
Form 6100-082 Discusion Guide - Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations	Form and Instruction	New	Repair queued
Form 5800-086 ARC-X User Satisfaction Survey	Form	New	Repair queued
Form 5800-0085 ECHO Tool Survey Questions	Form	New	Repair queued
Form 5800-084 Script for user interviews to support the development of a redesigned epa.gov/data web area	Form and Instruction	New	Repair queued
Form 9600-036 Lead Awareness Curriculum Session Train-the-Trainer Follow-up Survey	Form	New	Repair queued
Form 9600-035 Train-the-Trainer Post-Survey	Form	New	Repair queued
Form 9600-034 Understanding Lead Post-Survey	Form	New	Repair queued
Form 9600-033 Train-the-Trainer Pre-Survey	Form	New	Repair queued
Form 9600-032 Understanding Lead Pre-Survey	Form	New	Repair queued
Form 9600-031 Toxics Release Inventory (TRI) National Analysis User Survey	Form	New	Repair queued
Form 6100-078 Water Infrastructure Technical Assistance Request Form	Form	New	Repair queued
Form 6000-020 NAMs Training: Feedback (Post-Training	Form	New	Repair queued
Form 6000-019 NAMs Training: Registration / Pre-Training	Form	New	Repair queued
Form 6700-010 Far Eastside Survey	Form	New	Repair queued
Form 5800-081 DSIMB Standard Post-Training Questions	Form	New	Repair queued
Form 5900-577 Webcasts for Potential Updates to the Fact Sheets Associated with the Environmental Protection Agency’s Multi-Sector General Permit FY 2022	Form	New	Repair queued
Form 6000-018 2022 EPA DW Workshop Evaluation Questions-virtual attendees	Form	New	Repair queued
Form 6000-017 2022 EPA DW Workshop Evaluation Questions-In-person attendees	Form	New	Repair queued
Form 5800-079 SNC NCI ICIS-NPDES Data Completeness Survey	Form and Instruction	New	Repair queued
Form 6100-077 Technical Assistance Survey for Support Under the Bipartisan Infrastructure Law (BIL) FY 2022	Form	New	Repair queued
Form 6100-076 Core Survey	Form	New	Repair queued
Form 5800-076 Renovation, Repair and Painting Training Course Participant Survey	Form	New	Repair queued
Form 5800-075 Understanding Lead Webinar Survey	Form	New	Repair queued
Form 5800-074 Lead Awareness Curriculum Train-the-Trainer Survey	Form	New	Repair queued
Form 5800-073 Community Lead Awareness Survey	Form	New	Repair queued
Form 5800-072 EPA OECA Career Fair and Career Fair Website Survey	Form and Instruction	New	Repair queued
Form 5800-071 EPA OECA Career Fair Outreach and Information Group Survey	Form	New	Repair queued
Form 5900-577 Technical Assistance Survey for Support Under the Bipartisan Infrastructure Law (BIL)	Form	New	Repair queued
Form 5800-051 Campus RainWorks Survey	Form and Instruction	New	Repair queued
Form 5800-062 ORD Digital Design System Usability Evaluation Survey Follow up Survey Instruments	Form	New	Repair queued
Form 5800-065 Tribal Survey Questions	Form	New	Repair queued
Form 5800-064 Office of Acquisition Solutions (OAS) Online FOIA Survey	Form	New	Repair queued
CEJST Consolidated Survey	Form	New	Repair queued
Form 5900-525 Survey/Evaluation Questions for DW Workshop	Form and Instruction	New	Repair queued
Form 5900-524 Evaluation Survey: 18th Annual EPA Drinking Water Workshop: Small System Challenges and Solutions	Form	New	Repair queued
Form 5800-062 Research Participant Agreement and Consent Notice	Form	New	Repair queued
Form 5800-061 Research Participant Agreement and Consent Notice	Form	New	Repair queued
Form 5800-060 Federal Technology Transfer Act Questionaire	Form	New	Repair queued
Form 5800-059 Planning with Structured Decision Making/DASEES	Form	New	Repair queued
Form 5800-058 CAMD’s Clean Air Markets Program Data Beta Testing Survey	Form	New	Repair queued
Form 5800-050 Viburnum Trend Lead Haul Roads, Operable Unit 2 – St. Joe Minerals Corp, City of Viburnum Superfund Site Community Survey	Form	New	Available
Form 5800-049 Site User Satisfaction Survey	Form	New	Available
Form 5800-048 e-Manifest Electronic Manifest Questionnaire	Form	New	Available
Form 5800-047 Water Quality Standards Academy Evaluation Form	Form	New	Available
Form 5800-046 2021 TRI Website Satisfaction Survey	Form	New	Available
Form 5800-045 RY 2020 TRI-MEweb Application User Survey	Form	New	Available
Form 5800-044 Conference Evaluation Form 27th National Tanks Conference and Expo	Form	New	Available
Form 5800-043 Individual Session Evaluation Form 27th National Tanks Conference and Expo	Form	New	Available
Form 2010-0042 Survey of Certification Plan and Reporting Database Users – Evaluating User Access	Form	New	Available
Form 5800-042 EPA's Small Drinking Water Systems Webinar Series Survey	Form	New	Available
Form 5800-041 ORD State Engagement Feedback Survey	Form	New	Available
Form 5800-011 Science Matters Survey	Form	New	Available
Form 5800-010 Helpdesk Customer Satisfaction Survey for the Integrated Compliance Information System (ICIS) and the National Pollutant Discharge Elimination System (NPDES) eReporting Tools (NeT, NeTDMR)	Form	New	Available
Form 5800-040 HEALTHIER SCHOOL ENVIRONMENTS WORKSHOP CUSTOMER SATISFACTION SURVEY	Form	New	Available
Form 5800-039 Guest Speaker Survey	Form	New	Available
Form 5800-14 Discussion Guide	Form and Instruction	New	Available
Form 5800-015 Final Screener	Form and Instruction	New	Available
Form 5800-013 Los Angeles Public Library Patron Air Sensor Loan Survey	Form	New	Available
Form 5800-003 Customer Service Survey	Form	New	Available
Form 5800-007 EnviroAtlas Survey	Form	New	Available
Form 5800-016 EJScreen 2022 Impact Survey	Form	New	Available
Form 5800-038 eGRID User Satisfaction Survey	Form	New	Available
Form 5800-037 ECHO Post Training Survey Questions	Form	New	Available
Form 5800-036 Training Evaluation Survey	Form	New	Available
Form 5800-035 Meeting Facilitation Questionnaire	Form	New	Available
Form 5800-034 Long Term Group Facilitation Participant Questionnaire	Form	New	Available
Form 5800-033 Follow-up Effects Survey Participant Judicial Proceeding	Form	New	Available
Form 5800-032 Follow-up Effects Survey Participant Agency Decision	Form	New	Available
Form 5800-031 Follow-up Effects Survey Participant Administrative Proceeding	Form	New	Available
Form 5800-030 Follow-up Effects Survey Case Lead Judicial Proceeding	Form	New	Available
Form 5800-029 Follow-up Effects Survey Case Lead Agency Decision	Form	New	Available
Form 5800-028 Follow-up Effects Survey Case Lead Administrative Proceeding	Form	New	Available
Form 5800-027 Facilitated Dialogue Participant Questionnaire	Form	New	Available
Form 5800-026 Agreement Seeking Participant Judicial Proceeding Evaluation Survey	Form	New	Available
Form 5800-025 Agreement Seeking Participant Agency Decision Evaluation Survey	Form	New	Available
Form 5800-024 Agreement Seeking Participant Administrative Proceeding Evaluation Survey	Form	New	Available
Form 5800-023 Agreement Seeking Case Lead Judicial Proceeding Evaluation Survey	Form	New	Available
Form 5800-022 Agreement Seeking Case Lead Agency Decision Evaluation Survey	Form	New	Available
Form 5800-020 Agreement Seeking Case Lead Administrative Proceeding Evaluation Survey	Form	New	Available
Form 5800-0012 Evaluating Diesel Emissions Reduction Act (DERA) Program Customer Satisfaction in EPA Regions 9 and 10	Form	New	Available
Form 6200-021 America Recycles 2020 Event Survey & Pledge Signer Input	Form	New	Available
Form 5800-020 EPA Tools & Resources Webinar Series and EPA Science Training Webinars Evaluation Form	Form and Instruction	New	Available
Form 5800-019 CDX Help Desk Survey	Form and Instruction	New	Available
Form 5800-018 CDX Customer Satisfaction with Program Services	Form and Instruction	New	Available
Form 5800-017 User Survey	Form	New	Available
Instructions & Template for Generic Customer Service Collection Request.docx	Supplementary Document	Uploaded 2021-03-31	Available
2434ss99.docx	Supporting Statement A	Uploaded 2021-03-31	Available
2434ss99.docx	Supporting Statement B	Uploaded 2021-03-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
268726	Crisfield Resilience Academy	Form and Instruction	New	Crisfield 6-month Post-Academy Interview Protocol
268726	Crisfield Resilience Academy	Form	New	Crisfield Resilience Academy Session Evaluation
268726	Crisfield Resilience Academy	Form	New	CRISFIELD RESILIENCE ACADEMY: POST-SURVEY QUESTIONS
268726	Crisfield Resilience Academy	Form	New	CRISFIELD RESILIENCE ACADEMY: PRE-SURVEY QUESTIONS
267911	Feedback survey for participants of Healthy Homes and ECO Neighborhoods' learning experiences	Form	New	Healthy Homes Assessment and Energy Audit Feedback
267911	Feedback survey for participants of Healthy Homes and ECO Neighborhoods' learning experiences	Form	New	Healthy Homes and ECO Neighborhoods Survey
267910	Pipe Up Campaign Phase 3: Campaign Message Testing	Other-Focus Group Guide Intro Page	New
267773	Brownfields Minimizing Displacement Technical Assistance Participant Satisfaction Survey	Form	New	Minimizing Displacement Resulting from Brownfields Assessment, Cleanup and Reuse
267772	Customer Satisfaction Surveys for Feedback on Technical Assistance to Brownfield Communities	Form	New	Technical Assistance to Brownfield Communities – Evaluation Questions
267771	Land Revitalization Technical Assistance program (LRTA) Customer Satisfaction Survey	Form	New	Land Revitalization Technical Assistance to Brownfields Communities (LRTA) – Evaluation Questions
267448	Groundwork USA Nonprofit Technical Assistance Grant Satisfaction Surveys	Form	New	Groundwork USA Nonprofit Technical Assistance Grant Customer Satisfaction Survey
267440	Cuyahoga County Board of Health Feedback Activity during Health Impact Assessment Training Sessions	Form and Instruction	New	6700-082
267440	Cuyahoga County Board of Health Feedback Activity during Health Impact Assessment Training Sessions	Instruction	New
267372	Feedback Survey: NWEJC Launch Event	Form	New	Feedback Survey: Northwest Environmental Justice Center Launch Event
267007	Equitable Resilience Builder Tool Feedback Survey	Form	New	Equitable Resilience Builder Tool Feedback Survey
266980	Climate & Sustainability Event Survey for the GPCOG EJG2G Community Resilience Program	Form	New	Climate & Sustainability Event Survey
266979	Oʻahu Climate Champions Final Reflection	Form and Instruction	New	Climate Champion Final Reflection
266978	Oʻahu Climate Champions Monthly Reflections	Form and Instruction	New	Climate Champion Monthly Reflection
266585	Channelview ISD Teacher discussion to identify project priorities and needs for the 2024-25 school year	Instruction	New
266192	Lower Duwamish Waterway Superfund Site Institutional Control Implementation Assurance Plan (ICIAP) "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms	Form	New	Post-Assessment of CHAs-in-Training
266192	Lower Duwamish Waterway Superfund Site Institutional Control Implementation Assurance Plan (ICIAP) "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms	Form	New	Pre-Assessment of CHAs-in-Training
266192	Lower Duwamish Waterway Superfund Site Institutional Control Implementation Assurance Plan (ICIAP) "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms	Form	New	CHA Behavior Survey
266192	Lower Duwamish Waterway Superfund Site Institutional Control Implementation Assurance Plan (ICIAP) "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms	Form	New	Fishers Workshop Pledges (Multiple languages)
266192	Lower Duwamish Waterway Superfund Site Institutional Control Implementation Assurance Plan (ICIAP) "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms	Form	New	Fishers Workshop POST-Survey (Multiple Languages)
266192	Lower Duwamish Waterway Superfund Site Institutional Control Implementation Assurance Plan (ICIAP) "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms	Form	New	Fishers Workshop PRE-Survey (Multiple Languages)
266192	Lower Duwamish Waterway Superfund Site Institutional Control Implementation Assurance Plan (ICIAP) "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms	Form	New	Moms and Caregivers Background Survey (Multiple Languages)
266192	Lower Duwamish Waterway Superfund Site Institutional Control Implementation Assurance Plan (ICIAP) "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms	Form	New	Moms and Caregivers Mini Quiz (Multiple Languages)
266192	Lower Duwamish Waterway Superfund Site Institutional Control Implementation Assurance Plan (ICIAP) "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms	Form	New	Moms and Caregivers Pledges (Multiple Languages)
266192	Lower Duwamish Waterway Superfund Site Institutional Control Implementation Assurance Plan (ICIAP) "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms	Form	New	Moms and Caregivers Self-Assessment (Multiple Languages)
266192	Lower Duwamish Waterway Superfund Site Institutional Control Implementation Assurance Plan (ICIAP) "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms	Form	New	Public Health Seattle & King County EPA Outreach Event Survey
266156	Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline Survey	Form	New	Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline 2nd Survey
266156	Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline Survey	Form	New	Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline 1st Survey
266155	Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline Interview	Instruction	New
265850	OEJECR EJ Grantee Post-Orientation Feedback Survey	Form	New	OEJECR EJ Grantee Post-Orientation Feedback Survey
265162	LISS Partnership DEI/EJ Readiness Survey	Form	New	LISS Partnership DEI/EJ Survey
264927	Impact Analysis Questions for Communities in the Southeast New England Program Network (SNEP)	Form	New	Impact Analysis Questions for Communities
264550	2024 Northeast West Plains PFAS Drinking Water Sampling Event	Form and Instruction	New	NE West Plains PFAS Drinking Water Sampling Interest Questions
264199	Customer Satisfaction Surveys for feedback on the Community, Equity and Resiliency (CER) Regional Roadshow Events	Form	New	Community, Equity and Resiliency (CER) Regional Roadshow Events Survey
264020	Customer Satisfaction Surveys for intake of the EJ TCTACs	Form	New	EJ TCTAC Intake Form Center C
264020	Customer Satisfaction Surveys for intake of the EJ TCTACs	Form	New	EJ TCTAC Intake Form Center B
264020	Customer Satisfaction Surveys for intake of the EJ TCTACs	Form	New	EJ TCTAC Intake Form Center A
263997	Focus Group on Better Methods of Communicating Pesticide Label Information in Spanish	Other-Focus Group Script	New
263386	Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations	Instruction	New
263140	Customer Satisfaction Surveys for the Pesticide Safety Education Funds Management Program	Form	New	Customer Satisfaction Survey: Pesticide Safety Education Funds Management Program
262850	Community Change Technical Assistance	Form	New	Environmental and Climate Justice Community Change Technical Assistance Request Form
262848	Equitable Resilience Technical Assistance	Form	New	Equitable Resilience Technical Assistance for Community Change Grants - Request Form
262846	20th Annual EPA Drinking Water Workshop Attendee Survey of Satisfaction	Form	New	Evaluation Survey: EPA Annual Drinking Water Workshop: Small System Challenges and Solutions
262050	Gulf of Mexico Division Funding Opportunities	Form	New	Gulf of Mexico Division Funding Opportunities
261962	Survey for Smart Growth Network Quarterly Discussions	Form	New	Customer Service Questions for Smart Growth Network Quarterly Discussion
261903	Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations	Form and Instruction	New	Screener - Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations
261903	Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations	Form and Instruction	New	Discusion Guide - Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations
261760	Customer Satisfaction Survey for EPA's Adaptation Resource Center (ARC-X)	Form	New	ARC-X User Satisfaction Survey
261301	ECHO Tools Survey	Form	New	ECHO Tool Survey Questions
260905	Focus groups for feedback on the EJ TCTACs	Instruction	New
259688	User interviews to support the development of a redesigned epa.gov/data web area	Form and Instruction	New	Script for user interviews to support the development of a redesigned epa.gov/data web area
259641	Train-the-Trainer 6-month Post-Survey – Community Lead Awareness segment of Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO-CLA)	Form	New	Lead Awareness Curriculum Session Train-the-Trainer Follow-up Survey
259640	Train-the-Trainer Post-Survey – Community Lead Awareness segment of Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO-CLA)	Form	New	Train-the-Trainer Post-Survey
259639	Understanding Lead Post-Survey – Community Lead Awareness segment of Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO-CLA)	Form	New	Understanding Lead Post-Survey
259638	Train-the-Trainer Pre-Survey – Community Lead Awareness segment of Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO-CLA)	Form	New	Train-the-Trainer Pre-Survey
259621	Understanding Lead Pre-Survey – Community Lead Awareness segment of Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO-CLA)	Form	New	Understanding Lead Pre-Survey
259189	User interviews to support the development of a revamped epa.gov/data web area	Instruction	New
258833	TRI National Analysis Website Customer Satisfaction Survey	Form	New	Toxics Release Inventory (TRI) National Analysis User Survey
257526	Technical Assistance Survey for Support Under the Bipartisan Infrastructure Law (BIL) v. 3	Form	New	Water Infrastructure Technical Assistance Request Form
257524	NAMs Training Survey	Form	New	NAMs Training: Feedback (Post-Training
257524	NAMs Training Survey	Form	New	NAMs Training: Registration / Pre-Training
256773	Greening Urban Neighborhoods from the Ground Up	Form	New	Far Eastside Survey
256467	DSIMB – ICIS Customer Support Post Training Survey	Form	New	DSIMB Standard Post-Training Questions
256245	Industrial Stormwater Sector-Specific Fact Sheets Meetings for the Multi-Sector Industrial Stormwater Permit (MSGP)	Form	New	Webcasts for Potential Updates to the Fact Sheets Associated with the Environmental Protection Agency’s Multi-Sector General Permit FY 2022
255766	19th Annual EPA Drinking Water Workshop Attendee Survey of Satisfaction	Form	New	2022 EPA DW Workshop Evaluation Questions-virtual attendees
255766	19th Annual EPA Drinking Water Workshop Attendee Survey of Satisfaction	Form	New	2022 EPA DW Workshop Evaluation Questions-In-person attendees
255700	Data Completeness Survey for NPDES Significant Noncompliance National Compliance Initiative's Integrated Compliance Information System	Form and Instruction	New	SNC NCI ICIS-NPDES Data Completeness Survey
255540	Technical Assistance Survey for Support Under the Bipartisan Infrastructure Law (BIL)	Form	New	Technical Assistance Survey for Support Under the Bipartisan Infrastructure Law (BIL) FY 2022
254854	CORE Survey Questions (Students, Adults, and Community)	Form	New	Core Survey
254780	LRRP Survey - Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO	Form	New	Renovation, Repair and Painting Training Course Participant Survey
254778	Post-webinar Survey Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO)	Form	New	Understanding Lead Webinar Survey
254775	Post-Training Survey - Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO)	Form	New	Lead Awareness Curriculum Train-the-Trainer Survey
254774	Pre-Training Survey - Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO)	Form	New	Community Lead Awareness Survey
254090	EPA OECA Career Fair and Career Fair Website Survey	Form and Instruction	New	EPA OECA Career Fair and Career Fair Website Survey
252092	EPA OECA Career Fair Outreach and Information Group Survey	Form	New	EPA OECA Career Fair Outreach and Information Group Survey
251595	Technical Assistance Survey for Support Under the Bipartisan Infrastructure Law (BIL)	Form	New	Technical Assistance Survey for Support Under the Bipartisan Infrastructure Law (BIL)
251313	Campus RainWorks Challenge Survey	Form and Instruction	New	Campus RainWorks Survey
251216	ORD Digital Design System Usability Evaluation Survey Follow-up	Form	New	ORD Digital Design System Usability Evaluation Survey Follow up Survey Instruments
250158	Survey for feedback on Spring 2022 Region 5 State and Tribal Wetland Meeting	Form	New	Tribal Survey Questions
249976	Customer Satisfaction Survey for Lead Awareness in Indian Country: Keeping our Children Healthy! Curriculum (Lead Awareness Curriculum) Train-the-Trainer Sessions	Other-Survey Series	New
249945	Survey Tool Soliciting Input for Narragansett Bay Estuary Program's Diversity, Equity, Inclusion, and Justice Assessment	Instruction	New
249611	Office of Acquisition Solutions (OAS) Online FOIA Survey	Form	New	Office of Acquisition Solutions (OAS) Online FOIA Survey
249417	Climate and Economic Justice Screening Tool (CJEST) Site Satisfaction and Data Set Survey	Form	New	CEJST Consolidated Survey
249192	Interview Questions for the Integrated Compliance Information System (ICIS) Concept of Operations Business Requirements	Instruction	New
248994	Annual EPA Drinking Water Workshop Breakout Focus Groups Facilitation Questions and Attendee Survey of Satisfaction	Form and Instruction	New	Survey/Evaluation Questions for DW Workshop
248994	Annual EPA Drinking Water Workshop Breakout Focus Groups Facilitation Questions and Attendee Survey of Satisfaction	Form	New	Evaluation Survey: 18th Annual EPA Drinking Water Workshop: Small System Challenges and Solutions
248498	ORD Digital Design System Usability Evaluation Survey	Form	New	Research Participant Agreement and Consent Notice
248497	ORD Digital Design Industry Feedback	Form	New	Research Participant Agreement and Consent Notice
248373	Environmental Protection Agency Federal Technology Transfer Act Questionnaire	Form	New	Federal Technology Transfer Act Questionaire
248152	Planning with Structured Decision Making/DASEES	Form	New	Planning with Structured Decision Making/DASEES
248151	Clean Air Markets Division Beta Testing Survey	Form	New	CAMD’s Clean Air Markets Program Data Beta Testing Survey
246508	Survey Soliciting Input for Vision 2032 Plan	Other-Survey Questions	New
246393	Viburnum Trend Lead Haul Roads, Operable Unit 2 – St. Joe Minerals Corp, City of Viburnum Superfund Site Community Survey	Form	New	Viburnum Trend Lead Haul Roads, Operable Unit 2 – St. Joe Minerals Corp, City of Viburnum Superfund Site Community Survey
246262	Great Lakes AOC Project Area Community Use and Benefits Site User Satisfaction Survey	Form	New	Site User Satisfaction Survey
246261	e-Manifest Electronic Manifest Questionnaire	Form	New	e-Manifest Electronic Manifest Questionnaire
246231	EPA Water Quality Standards Academy Student Course Evaluation	Form	New	Water Quality Standards Academy Evaluation Form
246228	Toxics Release Inventory (TRI) Program Website Customer Satisfaction Survey	Form	New	2021 TRI Website Satisfaction Survey
246222	TRI-MEweb Customer Survey (Toxic Release Inventory – Made Easy Web)	Form	New	RY 2020 TRI-MEweb Application User Survey
246221	Evaluation Forms for the National Tanks Conference and Expo	Form	New	Conference Evaluation Form 27th National Tanks Conference and Expo
246221	Evaluation Forms for the National Tanks Conference and Expo	Form	New	Individual Session Evaluation Form 27th National Tanks Conference and Expo
246220	Survey of Certification Plan and Reporting Database Users – Evaluating User Access	Form	New	Survey of Certification Plan and Reporting Database Users – Evaluating User Access
246219	Office of Research and Development/Office of Water (ORD/OW) Small Systems Webinar Series Attendee Survey of Satisfaction	Form	New	EPA's Small Drinking Water Systems Webinar Series Survey
246203	Customer Satisfaction Survey for State Government Officials that Participated in the Office of Research and Development's FY2019-2022 Strategic Research Planning and Implementation Process	Form	New	ORD State Engagement Feedback Survey
246201	Office of Research and Development Science Matters Newsletter Customer Satisfaction Survey	Form	New	Science Matters Survey
246198	Helpdesk Customer Satisfaction Survey for the Integrated Compliance Information System (ICIS) and the National Pollutant Discharge Elimination System (NPDES) eReporting Tools (NeT, NeTDMR)	Form	New	Helpdesk Customer Satisfaction Survey for the Integrated Compliance Information System (ICIS) and the National Pollutant Discharge Elimination System (NPDES) eReporting Tools (NeT, NeTDMR)
246196	Customer Satisfaction Survey for Healthier School Environments Workshops	Form	New	HEALTHIER SCHOOL ENVIRONMENTS WORKSHOP CUSTOMER SATISFACTION SURVEY
246190	Guest Speaker Survey	Form	New	Guest Speaker Survey
246189	Pretesting Outreach and Web Materials for Fish Consumption Advisories	Form and Instruction	New	Discussion Guide
246189	Pretesting Outreach and Web Materials for Fish Consumption Advisories	Form and Instruction	New	Final Screener
246188	Evaluating the Pilot Los Angeles Public Library Sensor Loan Program: Patron Air Sensor Use Component	Form	New	Los Angeles Public Library Patron Air Sensor Loan Survey
246184	EPA Docket Center Customer Satisfaction Survey	Form	New	Customer Service Survey
246183	EnviroAtlas Survey	Form	New	EnviroAtlas Survey
246181	EJScreen 2022 Impact Survey	Form	New	EJScreen 2022 Impact Survey
246180	eGRID Customer Satisfaction Survey	Form	New	eGRID User Satisfaction Survey
246178	ECHO Post Training Survey Questions	Form	New	ECHO Post Training Survey Questions
246141	Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA	Form	New	Training Evaluation Survey
246141	Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA	Form	New	Meeting Facilitation Questionnaire
246141	Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA	Form	New	Long Term Group Facilitation Participant Questionnaire
246141	Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA	Form	New	Follow-up Effects Survey Participant Judicial Proceeding
246141	Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA	Form	New	Follow-up Effects Survey Participant Agency Decision
246141	Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA	Form	New	Follow-up Effects Survey Participant Administrative Proceeding
246141	Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA	Form	New	Follow-up Effects Survey Case Lead Judicial Proceeding
246141	Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA	Form	New	Follow-up Effects Survey Case Lead Agency Decision
246141	Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA	Form	New	Follow-up Effects Survey Case Lead Administrative Proceeding
246141	Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA	Form	New	Facilitated Dialogue Participant Questionnaire
246141	Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA	Form	New	Agreement Seeking Participant Judicial Proceeding Evaluation Survey
246141	Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA	Form	New	Agreement Seeking Participant Agency Decision Evaluation Survey
246141	Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA	Form	New	Agreement Seeking Participant Administrative Proceeding Evaluation Survey
246141	Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA	Form	New	Agreement Seeking Case Lead Judicial Proceeding Evaluation Survey
246141	Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA	Form	New	Agreement Seeking Case Lead Agency Decision Evaluation Survey
246141	Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA	Form	New	Agreement Seeking Case Lead Administrative Proceeding Evaluation Survey
246140	Evaluating Diesel Emissions Reduction Act (DERA) Program Customer Satisfaction in EPA Regions 9 and 10	Form	New	Evaluating Diesel Emissions Reduction Act (DERA) Program Customer Satisfaction in EPA Regions 9 and 10
246139	Customer Satisfaction Survey for the America Recycles Events	Form	New	America Recycles 2020 Event Survey & Pledge Signer Input
246129	Office of Research & Development's EPA Tools & Resources Webinar Series and EPA Science Training Webinars - Attendee Satisfaction Survey	Form and Instruction	New	EPA Tools & Resources Webinar Series and EPA Science Training Webinars Evaluation Form
246127	Central Data Exchange (CDX) Help Desk Survey	Form and Instruction	New	CDX Help Desk Survey
246125	Central Data Exchange (CDX) Customer Satisfaction Survey	Form and Instruction	New	CDX Customer Satisfaction with Program Services
246087	Office of Administrative Law Judges Alternative Dispute Resolution Process User Survey	Form	New	User Survey

ICR Details

OMB Control No: 2030-0051	ICR Reference No: 202106-2030-001
Status: Historical Active	Previous ICR Reference No: 201711-2010-001
Agency/Subagency: EPA/OMS	Agency Tracking No: 2434.99
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (Renewal)
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: 06/21/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/21/2021
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.”

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2024	36 Months From Approved
Responses	180,000	0	120,000
Time Burden (Hours)	45,000	0	30,000
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is designed to support multiple Agency efforts to gather information about its products and service delivery from the public and other stakeholders. The types of collections that this generic clearance covers include, but are not limited to, qualitative customer satisfaction surveys, observational testing, and focus groups. Subjects of study may include EPA conferences, workshops, trainings, webinars, and web resources as well as the interaction the public has with our helpdesks, processing centers, and educational outreach efforts. Getting such feedback in a timely manner is critical if the Agency is to know how and where it should focus while seeking to improve, or expand upon, its products and services. EPA shall comply with OMB’s requirements for activities approved under a generic clearance. Namely, they must be: voluntary; low burden and low-cost for both the respondents and the Federal Government; noncontroversial; targeted to respondents who have experience with the program or may have experience with the program in the near future; and abstain from collecting personally identifiable information (PII) to the greatest extent possible. Information gathered will be used internally for general service improvement and program management purposes and released publicly only in an anonymized or aggregated fashion. It will not be used in statistical analysis intended to yield results that can be generalized to the population of study nor will it be used to substantially inform influential policy decisions.

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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:
	85 FR 43236	07/16/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 16208	03/26/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 102

table that charts list of burden

IC Title	Form No.	Form Name
LISS Partnership DEI/EJ Readiness Survey	6700-025	LISS Partnership DEI/EJ Survey
19th Annual EPA Drinking Water Workshop Attendee Survey of Satisfaction	6000-017, 6000-018	2022 EPA DW Workshop Evaluation Questions-In-person attendees ,   2022 EPA DW Workshop Evaluation Questions-virtual attendees
2024 Northeast West Plains PFAS Drinking Water Sampling Event	6700-024	NE West Plains PFAS Drinking Water Sampling Interest Questions
20th Annual EPA Drinking Water Workshop Attendee Survey of Satisfaction	6000-027	Evaluation Survey: EPA Annual Drinking Water Workshop: Small System Challenges and Solutions
Annual EPA Drinking Water Workshop Breakout Focus Groups Facilitation Questions and Attendee Survey of Satisfaction	5900-524, 5900-525	Evaluation Survey: 18th Annual EPA Drinking Water Workshop: Small System Challenges and Solutions ,   Survey/Evaluation Questions for DW Workshop
Brownfields Minimizing Displacement Technical Assistance Participant Satisfaction Survey	6200-030	Minimizing Displacement Resulting from Brownfields Assessment, Cleanup and Reuse
CORE Survey Questions (Students, Adults, and Community)	6100-076	Core Survey
Campus RainWorks Challenge Survey	5800-051	Campus RainWorks Survey
Central Data Exchange (CDX) Customer Satisfaction Survey	5800-018	CDX Customer Satisfaction with Program Services
Central Data Exchange (CDX) Help Desk Survey	5800-019	CDX Help Desk Survey
Channelview ISD Teacher discussion to identify project priorities and needs for the 2024-25 school year
Clean Air Markets Division Beta Testing Survey	5800-058	CAMD’s Clean Air Markets Program Data Beta Testing Survey
Climate & Sustainability Event Survey for the GPCOG EJG2G Community Resilience Program	6700-031	Climate & Sustainability Event Survey
Climate and Economic Justice Screening Tool (CJEST) Site Satisfaction and Data Set Survey	N/A	CEJST Consolidated Survey
Community Change Technical Assistance	5800-089	Environmental and Climate Justice Community Change Technical Assistance Request Form
Crisfield Resilience Academy	6000-023, 6000-024, 6000-025, 6000-026	CRISFIELD RESILIENCE ACADEMY: PRE-SURVEY QUESTIONS ,   CRISFIELD RESILIENCE ACADEMY: POST-SURVEY QUESTIONS ,   Crisfield Resilience Academy Session Evaluation ,   Crisfield 6-month Post-Academy Interview Protocol
Customer Satisfaction Survey for EPA's Adaptation Resource Center (ARC-X)	5800-086	ARC-X User Satisfaction Survey
Customer Satisfaction Survey for Healthier School Environments Workshops	5800-040	HEALTHIER SCHOOL ENVIRONMENTS WORKSHOP CUSTOMER SATISFACTION SURVEY
Customer Satisfaction Survey for Lead Awareness in Indian Country: Keeping our Children Healthy! Curriculum (Lead Awareness Curriculum) Train-the-Trainer Sessions
Customer Satisfaction Survey for State Government Officials that Participated in the Office of Research and Development's FY2019-2022 Strategic Research Planning and Implementation Process	5800-041	ORD State Engagement Feedback Survey
Customer Satisfaction Survey for the America Recycles Events	6200-021	America Recycles 2020 Event Survey & Pledge Signer Input
Customer Satisfaction Surveys for Feedback on Technical Assistance to Brownfield Communities	6200-031	Technical Assistance to Brownfield Communities – Evaluation Questions
Customer Satisfaction Surveys for feedback on the Community, Equity and Resiliency (CER) Regional Roadshow Events	5800-090	Community, Equity and Resiliency (CER) Regional Roadshow Events Survey
Customer Satisfaction Surveys for intake of the EJ TCTACs	5800-091, 5800-092, 5800-093	EJ TCTAC Intake Form Center A ,   EJ TCTAC Intake Form Center B ,   EJ TCTAC Intake Form Center C
Customer Satisfaction Surveys for the Pesticide Safety Education Funds Management Program	9600-056	Customer Satisfaction Survey: Pesticide Safety Education Funds Management Program
Cuyahoga County Board of Health Feedback Activity during Health Impact Assessment Training Sessions	HIA Training Feedback Storytelling Activity	6700-082
DSIMB – ICIS Customer Support Post Training Survey	5800-081	DSIMB Standard Post-Training Questions
Data Completeness Survey for NPDES Significant Noncompliance National Compliance Initiative's Integrated Compliance Information System	5800-079	SNC NCI ICIS-NPDES Data Completeness Survey
ECHO Post Training Survey Questions	5800-037	ECHO Post Training Survey Questions
ECHO Tools Survey	5800-0085	ECHO Tool Survey Questions
EJScreen 2022 Impact Survey	5800-016	EJScreen 2022 Impact Survey
EPA Docket Center Customer Satisfaction Survey	5800-003	Customer Service Survey
EPA OECA Career Fair Outreach and Information Group Survey	5800-071	EPA OECA Career Fair Outreach and Information Group Survey
EPA OECA Career Fair and Career Fair Website Survey	5800-072	EPA OECA Career Fair and Career Fair Website Survey
EPA Water Quality Standards Academy Student Course Evaluation	5800-047	Water Quality Standards Academy Evaluation Form
EnviroAtlas Survey	5800-007	EnviroAtlas Survey
Environmental Protection Agency Federal Technology Transfer Act Questionnaire	5800-060	Federal Technology Transfer Act Questionaire
Equitable Resilience Builder Tool Feedback SurveyÂ	6000-030	Equitable Resilience Builder Tool Feedback SurveyÂ
Equitable Resilience Technical Assistance	5800-088	Equitable Resilience Technical Assistance for Community Change Grants - Request Form
Evaluating Diesel Emissions Reduction Act (DERA) Program Customer Satisfaction in EPA Regions 9 and 10	5800-0012	Evaluating Diesel Emissions Reduction Act (DERA) Program Customer Satisfaction in EPA Regions 9 and 10
Evaluating the Pilot Los Angeles Public Library Sensor Loan Program: Patron Air Sensor Use Component	5800-013	Los Angeles Public Library Patron Air Sensor Loan Survey
Evaluation Forms for the National Tanks Conference and Expo	5800-043, 5800-044	Individual Session Evaluation Form 27th National Tanks Conference and Expo ,   Conference Evaluation Form 27th National Tanks Conference and Expo
Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA	5800-028, 5800-031, 5800-022, 5800-020, 5800-024, 5800-023, 5800-025, 5800-026, 5800-027, 5800-029, 5800-030, 5800-032, 5800-033, 5800-034, 5800-035, 5800-036	Agreement Seeking Case Lead Administrative Proceeding Evaluation Survey ,   Agreement Seeking Case Lead Agency Decision Evaluation Survey ,   Agreement Seeking Case Lead Judicial Proceeding Evaluation Survey ,   Agreement Seeking Participant Administrative Proceeding Evaluation Survey ,   Agreement Seeking Participant Agency Decision Evaluation Survey ,   Agreement Seeking Participant Judicial Proceeding Evaluation Survey ,   Facilitated Dialogue Participant Questionnaire ,   Follow-up Effects Survey Case Lead Administrative Proceeding ,   Follow-up Effects Survey Case Lead Agency Decision ,   Follow-up Effects Survey Case Lead Judicial Proceeding ,   Follow-up Effects Survey Participant Administrative Proceeding ,   Follow-up Effects Survey Participant Agency Decision ,   Follow-up Effects Survey Participant Judicial Proceeding ,   Long Term Group Facilitation Participant Questionnaire ,   Meeting Facilitation Questionnaire ,   Training Evaluation Survey
Feedback Survey: NWEJC Launch Event	5800-095	Feedback Survey: Northwest Environmental Justice Center Launch Event
Feedback survey for participants of Healthy Homes and ECO Neighborhoods' learning experiences	6700-034, 6700-035	Healthy Homes and ECO Neighborhoods Survey ,   Healthy Homes Assessment and Energy Audit Feedback
Focus Group on Better Methods of Communicating Pesticide Label Information in Spanish
Focus groups for feedback on the EJ TCTACs
Great Lakes AOC Project Area Community Use and Benefits Site User Satisfaction Survey	5800-049	Site User Satisfaction Survey
Greening Urban Neighborhoods from the Ground Up	6700-010	Far Eastside Survey
Groundwork USA Nonprofit Technical Assistance Grant Satisfaction Surveys	6200-033	Groundwork USA Nonprofit Technical Assistance Grant Customer Satisfaction Survey
Guest Speaker Survey	5800-039	Guest Speaker Survey
Gulf of Mexico Division Funding Opportunities	6700-912	Gulf of Mexico Division Funding Opportunities
Helpdesk Customer Satisfaction Survey for the Integrated Compliance Information System (ICIS) and the National Pollutant Discharge Elimination System (NPDES) eReporting Tools (NeT, NeTDMR)	5800-010	Helpdesk Customer Satisfaction Survey for the Integrated Compliance Information System (ICIS) and the National Pollutant Discharge Elimination System (NPDES) eReporting Tools (NeT, NeTDMR)
Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline Interview
Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline Survey	6700-028, 6700-027	Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline 1st Survey ,   Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline 2nd Survey
Impact Analysis Questions for Communities in the Southeast New England Program Network (SNEP)	6700-011	Impact Analysis Questions for Communities
Industrial Stormwater Sector-Specific Fact Sheets Meetings for the Multi-Sector Industrial Stormwater Permit (MSGP)	5900-577	Webcasts for Potential Updates to the Fact Sheets Associated with the Environmental Protection Agency’s Multi-Sector General Permit FY 2022
Interview Questions for the Integrated Compliance Information System (ICIS) Concept of Operations Business Requirements
LRRP Survey - Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO	5800-076	Renovation, Repair and Painting Training Course Participant Survey
Land Revitalization Technical Assistance program (LRTA) Customer Satisfaction Survey	6200-035	Land Revitalization Technical Assistance to Brownfields Communities (LRTA) – Evaluation Questions
Lower Duwamish Waterway Superfund Site Institutional Control Implementation Assurance Plan (ICIAP) "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms	6700-013, 6700-014, 6700-015, 6700-016, 6700-017, 6700-018, 6700-019, 6700-020, 6700-021, 6700-022, 6700-023	Public Health Seattle & King County EPA Outreach Event Survey ,   Moms and Caregivers Self-Assessment (Multiple Languages) ,   Moms and Caregivers Pledges (Multiple Languages) ,   Moms and Caregivers Mini Quiz (Multiple Languages) ,   Moms and Caregivers Background Survey (Multiple Languages) ,   Fishers Workshop PRE-Survey (Multiple Languages) ,   Fishers Workshop POST-Survey (Multiple Languages) ,   Fishers Workshop Pledges (Multiple languages) ,   CHA Behavior Survey ,   Pre-Assessment of CHAs-in-Training ,   Post-Assessment of CHAs-in-Training
NAMs Training Survey	6000-019, 6000-020	NAMs Training: Registration / Pre-Training ,   NAMs Training: Feedback (Post-Training
OEJECR EJ Grantee Post-Orientation Feedback Survey	5800-094	OEJECR EJ Grantee Post-Orientation Feedback Survey
ORD Digital Design Industry Feedback	5800-061	Research Participant Agreement and Consent Notice
ORD Digital Design System Usability Evaluation Survey	5800-062	Research Participant Agreement and Consent Notice
ORD Digital Design System Usability Evaluation Survey Follow-up	5800-062	ORD Digital Design System Usability Evaluation Survey Follow up Survey Instruments
Office of Acquisition Solutions (OAS) Online FOIA Survey	5800-064	Office of Acquisition Solutions (OAS) Online FOIA Survey
Office of Administrative Law Judges Alternative Dispute Resolution Process User Survey	5800-017	User Survey
Office of Research & Development's EPA Tools & Resources Webinar Series and EPA Science Training Webinars - Attendee Satisfaction Survey	5800-020	EPA Tools & Resources Webinar Series and EPA Science Training Webinars Evaluation Form
Office of Research and Development Science Matters Newsletter Customer Satisfaction Survey	5800-011	Science Matters Survey
Office of Research and Development/Office of Water (ORD/OW) Small Systems Webinar Series Attendee Survey of Satisfaction	5800-042	EPA's Small Drinking Water Systems Webinar Series Survey
Oʻahu Climate Champions Final Reflection	6700-030	Climate Champion Final Reflection
Oʻahu Climate Champions Monthly Reflections	6700-029	Climate Champion Monthly Reflection
Pipe Up Campaign Phase 3: Campaign Message Testing
Planning with Structured Decision Making/DASEES	5800-059	Planning with Structured Decision Making/DASEES
Post-Training Survey - Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO)	5800-074	Lead Awareness Curriculum Train-the-Trainer Survey
Post-webinar Survey Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO)	5800-075	Understanding Lead Webinar Survey
Pre-Training Survey - Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO)	5800-073	Community Lead Awareness Survey
Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations	6100-082, 6100-081	Discusion Guide - Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations ,   Screener - Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations
Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations
Pretesting Outreach and Web Materials for Fish Consumption Advisories	5800-015, 5800-14	Final Screener ,   Discussion Guide
Survey Soliciting Input for Vision 2032 Plan
Survey Tool Soliciting Input for Narragansett Bay Estuary Program's Diversity, Equity, Inclusion, and Justice Assessment
Survey for Smart Growth Network Quarterly Discussions	5800-087	Customer Service Questions for Smart Growth Network Quarterly Discussion
Survey for feedback on Spring 2022 Region 5 State and Tribal Wetland Meeting	5800-065	Tribal Survey Questions
Survey of Certification Plan and Reporting Database Users – Evaluating User Access	2010-0042	Survey of Certification Plan and Reporting Database Users – Evaluating User Access
TRI National Analysis Website Customer Satisfaction Survey	9600-031	Toxics Release Inventory (TRI) National Analysis User Survey
TRI-MEweb Customer Survey (Toxic Release Inventory – Made Easy Web)	5800-045	RY 2020 TRI-MEweb Application User Survey
Technical Assistance Survey for Support Under the Bipartisan Infrastructure Law (BIL)	5900-577	Technical Assistance Survey for Support Under the Bipartisan Infrastructure Law (BIL)
Technical Assistance Survey for Support Under the Bipartisan Infrastructure Law (BIL)	6100-077	Technical Assistance Survey for Support Under the Bipartisan Infrastructure Law (BIL) FY 2022
Technical Assistance Survey for Support Under the Bipartisan Infrastructure Law (BIL) v. 3	6100-078	Water Infrastructure Technical Assistance Request Form
Toxics Release Inventory (TRI) Program Website Customer Satisfaction Survey	5800-046	2021 TRI Website Satisfaction Survey
Train-the-Trainer 6-month Post-Survey – Community Lead Awareness segment of Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO-CLA)	9600-036	Lead Awareness Curriculum Session Train-the-Trainer Follow-up Survey
Train-the-Trainer Post-Survey – Community Lead Awareness segment of Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO-CLA)	9600-035	Train-the-Trainer Post-Survey
Train-the-Trainer Pre-Survey – Community Lead Awareness segment of Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO-CLA)	9600-033	Train-the-Trainer Pre-Survey
Understanding Lead Post-Survey – Community Lead Awareness segment of Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO-CLA)	9600-034	Understanding Lead Post-Survey
Understanding Lead Pre-Survey – Community Lead Awareness segment of Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO-CLA)	9600-032	Understanding Lead Pre-Survey
User interviews to support the development of a redesigned epa.gov/data web area	5800-084	Script for user interviews to support the development of a redesigned epa.gov/data web area
User interviews to support the development of a revamped epa.gov/data web area
Viburnum Trend Lead Haul Roads, Operable Unit 2 – St. Joe Minerals Corp, City of Viburnum Superfund Site Community Survey	5800-050	Viburnum Trend Lead Haul Roads, Operable Unit 2 – St. Joe Minerals Corp, City of Viburnum Superfund Site Community Survey
e-Manifest Electronic Manifest Questionnaire	5800-048	e-Manifest Electronic Manifest Questionnaire
eGRID Customer Satisfaction Survey	5800-038	eGRID User Satisfaction Survey

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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	180,000	120,000	0	0	60,000	0
Annual Time Burden (Hours)	45,000	30,000	0	0	15,000	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: The number of anticipated responses and total burden hours have been adjusted upward by 50% to accommodate continued growth of the Agency’s use of this generic collection.

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Annual Cost to Federal Government: $18,000

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? No

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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: 03/31/2021

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