Form 5800-042 EPA's Small Drinking Water Systems Webinar Series Survey

Request for Approval under the “Generic Clearance for the Collection of
Routine Customer Feedback” (OMB Control Number: 2010-0042)
TITLE OF INFORMATION COLLECTION: Office of Research and Development/Office
of Water (ORD/OW) Small Systems Webinar Series attendee survey of satisfaction.
PURPOSE: To collect quantitative and qualitative feedback on the ORD/OW Small Systems
Webinar Series to justify its continuance. This includes feedback on the content/topics and
presenters of past webinars, as well as suggestions/recommendations for future webinars and
outreach collaboration.
DESCRIPTION OF RESPONDENTS: Respondents to include attendees of the ORD/OW
Small Systems Monthly Webinar Series. Attendees typically include representatives from federal
(including military)/state/territory/local governments, Tribes, public and private utilities,
consultants/technical service providers, technology developers/manufacturers,
academia/education, NGO/associations/foundations, medical/hospital workers, and
media/reporters.
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 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: Michelle Latham, ORD/IOAA __________________________________
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

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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

State, local, and territory and
governments and tribes
Private sector

1300

NGOs

100

Academia

100

1 minute per question
(8 questions)
1 minute per question
(8 questions)
1 minute per question
(8 questions)
1 minute per question
(8 questions)
1 minute per question
(8 questions)

Totals

600

2,100

Burden
Hours
173
80
13
13
280

FEDERAL COST: The estimated annual cost to the Federal government is _~$500.00_
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?
The respondent list is derived from the registration record of the combined webinars described in
the “Description of Respondents” section. A list is maintained under contract by the Cadmus
group for the purpose of communicating to the group on upcoming webinars and other drinking
water related events.
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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OMB Control Number: 2010-0042
Expiration Date: 3/31/21

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