EBSA Participant Assistance Program Customer Survey

Forms and Documents

Document Name	Status
GPRA Resources - DOL website.pdf Supplementary Document	2021-09-30
PUBLIC LAW 111–352 -GPRA Modernization Act of 2010.pdf Supplementary Document	2021-09-30
Public Law 103-62 - GPRA.pdf Supplementary Document	2021-09-30
30-day FRN (1210-0161) published.pdf Supplementary Document	2021-09-30
60-day FRN (1210-0161) published.pdf Supplementary Document	2021-09-29
signed_PRA Signature Form_EBSA_(2021_0928).pdf Supplementary Document	2021-09-29
2021 PAP Satisfaction Survey - Part A and B 9-20-2021 (clean).docx Supporting Statement B	2021-09-20
2021 PAP Satisfaction Survey - Part A and B 9-29-2021 clean.docx Supporting Statement A	2021-09-29

IC Document Collections

IC ID	Document Title	Status
238857	EBSA Participant Assistance Program Customer Survey Other-Survey Instrument	Modified

ICR Details

OMB Control No: 1210-0161	ICR Reference No: 202109-1210-001
Status: Received in OIRA	Previous ICR Reference No: 201912-1210-001
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: EBSA Participant Assistance Program Customer Survey
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/30/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2023
Responses	11,200	11,200
Time Burden (Hours)	1,867	1,493
Cost Burden (Dollars)	0	0

---

Abstract: The purpose of this data collection effort is to solicit inquirers’ feedback and compile reports on the applicability and utility of EBSA’s Participant Assistance Program. This survey will collect customer satisfaction data for a sample of private citizens who call into the participant assistance program to ask about their private sector employer provided benefits such as pensions, retirement savings, and health benefits.

---

Authorizing Statute(s): None

Citations for New Statutory Requirements: EO: EO 13985 Name/Subject of EO: Advancing Racial Equity and Support for Underserved Communities Through the Federal Government

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 38500	07/21/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 54245	09/30/2021
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
EBSA Participant Assistance Program Customer Survey

---

ICR Summary of Burden

	Total Request	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	11,200	11,200	0	0	0	0
Annual Time Burden (Hours)	1,867	1,493	374	0	0	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 survey’s demographic questions have been updated in response to Executive Order 13985—Advancing Racial Equity and Support for Underserved Communities Through the Federal Government. Each survey should take approximately an additional two minutes to complete.

---

Annual Cost to Federal Government: $696,085

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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

---

Common Form ICR:  No

---

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: 09/30/2021

---