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

Forms and Documents

Document Name	Status
Form 0920 [ATSDR] Heat and Health Tracker Evaluation Survey Form and Instruction	New
Form 0923-0047 [ATSDR] Environmental Justice Index Workshop Feedback Surveys Form and Instruction	New
[ATSDR] Environmental Health and Land Reuse (EHLR) Immersion Training Pilots Form and Instruction	New
Att 4 ATSDR 0923-0047 GnrcClrncQualFdbkTmpltapprvlFrm.docx Supplementary Document	2021-10-29
Att 3- Srvc Dlvry HS Determination.pdf Supplementary Document	2021-10-29
Att 2 60D FRN 0923-0047 2021.pdf Supplementary Document	2021-10-29
1 - ATSDR 0923-0047 Extnsn 2021 SSB.docx Supporting Statement B	2021-10-29
Att 1 EO12862 - Authority.pdf Supplementary Document	2021-10-29
1 - ATSDR 0923-0047 Extnsn 2021 SSAv2.docx Supporting Statement A	2021-10-29

IC Document Collections

IC ID	Document Title	Status
259022	[ATSDR] Heat and Health Tracker Evaluation Survey Form and Instruction	New
258785	[ATSDR] Environmental Justice Index Workshop Feedback Surveys Form and Instruction	New
258593	[ATSDR] Environmental Health and Land Reuse (EHLR) Immersion Training Pilots Form and Instruction	New

ICR Details

OMB Control No: 0923-0047	ICR Reference No: 202110-0923-002
Status: Received in OIRA	Previous ICR Reference No: 201810-0923-002
Agency/Subagency: HHS/TSDR	Agency Tracking No: Docket ATSDR-2021-0003
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 11/16/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2022
Responses	24,900	24,900
Time Burden (Hours)	21,225	21,225
Cost Burden (Dollars)	0	0

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Abstract: This collection of information is necessary to enable the Agency to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the Agency's programs. Each project-specific information collection (GENIC) will be submitted to OMB for approval.

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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:
	86 FR 16212	03/26/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 63392	11/16/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 0

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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	24,900	24,900	0	0	0	0
Annual Time Burden (Hours)	21,225	21,225	0	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:

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Annual Cost to Federal Government: $500,000

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

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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: 11/16/2021

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