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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0704-0553_SSA_3.28.22.docx	Supporting Statement A	Uploaded 2022-03-28	Repair queued
0704-0553_SSB_3.9.22.docx	Supporting Statement B	Uploaded 2022-03-17	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
275232	DAF Community Involvement Plan (CIP) Community Surveys	Other-Survey	New
275219	Marine Corps Systems Command (MARCORSYSCOM) Vendor Survey	Other-Web Survey	New
275180	Air Force Combined Mishap Reduction System Surveys for 96 TW & 53 WG	Other-Survey	New
275179	Patient Experience Informal Interviews	Other-Interview Questions	New
275178	Patient Journey Mapping Journals	Other-Journey Map Journal	New
274464	dha.mil Website Satisfaction Surveys	Other-Web Survey	New
273652	Pharmacy Patient Satisfaction Survey	Other-Script	New
273649	User feedback from the DOD Survivor Symposium	Other-Survey	New
273406	National Security Space Institute (NSSI) End of Course Survey	Other-Web Survey	New
273219	Marine Corps Recruiting Depot (MCRD) San Diego Spouses Survey for MCFTB Event Planning Improvement	Other-Survey	New
272867	USMC SAPR Services Satisfaction Survey	Other-Web Survey	New
272864	USMC Behavioral Programs Standardized Satisfaction Survey	Other-Web Survey	New
272358	Marine Corps Exchange (MCX) Main Store Feedback Survey	Other-Web Survey	New
272306	Military OneSource Triage Experience Survey	Other-Survey	New
272233	Nurse Advice Line Patient Experience Survey	Other-Survey	New
272227	Customer Satisfaction Incentive Surveys	Other-Survey	New
272072	Tinker Air Force Base Provisioning Conference Satisfaction Survey	Other-Web Survey	New
271788	Marine Corps Exchange (MCX) Marine Mart Customer Feedback Survey	Other-Web Survey	New
271785	DOD Survivor Symposium User Feedback Survey	Other-Protocol	New
271535	Public Health Messaging Survey	Other-Survey	New
271320	DoD Housing Resident Satisfaction Survey	Other-Survey	New
271142	Tulsa District Boater and Stakeholder Feedback Surveys	Other-Survey	New
270771	CDAO Agile Adoption Feedback Questionnaire	Other-Web Survey	New
270708	Naval Hospital Rota Access to Care Survey	Other-Survey	New
270645	Military Health System Electronic Health Record End User Survey	Other-survey	New
270193	Air Education and Training Command (AETC) Technical Training Management System (TTMS) End of Course Survey	Other-Survey	New
269567	IV Access Patient Survey	Other-Survey	New
269561	Military Community Outreach Feedback Survey	Other-Survey	New
269547	Tier 1, 2 and 3 Helpdesk Customer Satisfaction Feedback Survey	Other-Survey	New
269399	Customer Feedback on Marine Corps Community Services (MCCS) Food and Beverage Activities	Other-Web Survey	New
269273	Camp Butler Youth Sports Program Surveys	Other-Survey	New
269123	Pulse User Feedback Survey	Other-Survey	New
269025	Customer Satisfaction of Military Community Support Programs Services – MCSP Site Visits	Other-Survey	New
268487	DOD Survivor Symposium User Feedback Survey	Other-Survey	New
267669	Fresh Meat and Produce Customer Satisfaction Survey	Other-Survey	New
267547	Air University "Final 4" Exit Survey	Other-Survey	New
267546	Air University International Officer School (IOS) Follow-On and Site Surveys	Other-Survey	New
267545	Air University International Officer School (IOS) Exit Surveys	Other-Survey	New
267498	CATMS Touchpoints Survey	Other-Survey	New
267214	Customer Satisfaction of Military Community Support Programs Services-Military OneSource Call Center Counseling	Other-Survey	New
267201	Customer Satisfaction of Military OneSource Call Center - Specialty Services	Other-Survey	New
266851	MHS Facilities Design Survey	Other-Telephone Survey	New
266844	TRICARE.mil and Health.mil Website Satisfaction Surveys	Other-Web Survey	New
266785	JB Charleston EFMP-Family Support Survey	Other-Survey	New
266321	Hill AFB Pharmacy Satisfaction Survey	Other-Survey	New
266201	Patient Navigator Pilot Survey	Other-Web Survey	New
266157	Lejeune-New River School Age Care Child Youth Programs Survey	Other-Paper Survey	New
265082	Domestic Abuse Victims Advocate Certification and Training Evaluation Plan (PWS 4.3) – DAVA Training Feedback	Other-Survey	New
264977	Marine Corps Community Services (MCCS) Market Assessment Focus Group	Other-Focus Group Protocol	New
264815	Forensic eXploitation Department Post-Mentorship Feedback Survey	Other-Web Survey	New
264742	West Point Band Performance Feedback Survey	Other-Web Survey	New
264491	Accredo TRICARE Specialty Pharmacy Survey	Other-Telephone Survey	New
264339	Department of Defense Domestic Abuse Victim Advocate (DAVA) feedback for the National Organization of Victim Advocates (NOVA) information session	Other-Survey	New
264228	Customer Satisfaction of Military Community Support Programs Services-Military OneSource Call Center Counseling	Other-Survey	New
264227	Customer Satisfaction of Military OneSource Call Center - Specialty Services	Other-Survey	New
264225	Customer Satisfaction of Military Community Support Programs Services-Military OneSource Call Center Support Services	Other-Survey	New
264046	NSA Candidate Feedback Survey	Other-Survey	New
263970	Military Childcare Family User Survey and Program User Survey	Other-Survey	New
263958	Customer Satisfaction of Military Community Support Programs Services-Military OneSource Call Center Special Populations	Other-Survey	New
263609	JPSR Office Hour Survey	Other-Survey	New
263501	Comment Card for soliciting feedback from people attending the Heartland Band 2023 SOUNDS of the SEASON musical production	Other-Suvey	New
263177	Forensic eXploitation Department Internal Training Feedback Survey	Other-Web Survey	New
263151	Matter of Balance Program	Other-Interview guide	New
263149	Mark Center LEED Transportation and Human Experience Survey	Other-Survey	New
262845	Enterprise Task Management Software Solution (ETMS2) Training and Customer Satisfaction Survey	Other-Web Survey	New
262774	Digital Front Door Virtual Health for Beneficiaries	Other-Survey	New
262772	WHS Customer Experience Survey	Other-Survey	New
261654	Military OneSource Call Center Feedback	Other-Survey	New
261210	Team Submarine (TSUB) Core Values ACT Campaign Pulse Check Survey	Other-Web Survey	New
261100	DHA J-5 Town Hall	Other-Survey	New
261047	Advana Contractor User Survey	Other-Survey	New
260798	Voluntary Environmental Cleanup Communication and Outreach Initiative (ECCOI) Community Member Questionnaire	Other-Web Survey	New
260633	PEO MLB Voice of the Customer (VoC) Survey	Other-Web Survey	New
260562	Customer Feedback on the Marine Corps Exchange (MCX) DoD Issued ID Card Scan Pilot	Other-Survey	New
260210	Fixed Asset Module Implementation Survey	Other-Survey Instrument	New
259730	637th Training Group Defense Language Institute English Language Center (DLIELC) Post Graduate Survey	Other-Survey	New
259622	DSCA Regional Center AM&E Program Survey	Other-	New
259285	DAF Applications and A1 Applications Online Feedback Surveys	Other-Web Survey	New
259122	Customer Satisfaction of Military Community Support Programs Services	Other-Survey	New
257940	Columbia Class Program Office (PMS 397) Professional Growth and Empowerment Event Reaction Survey	Other-Web Survey	New
257299	Quarterly Pentagon, Mark Center, and Suffolk Building Parking Survey	Other-Screenshot	New
256796	NAVSUP FLC Bahrain Foreign Workforce Climate Survey	Other-Web Survey	New
256520	Marshall Center Alumni Survey 2002-2022	Other-Web Survey	New
256364	MilLife Learning Foresee Feedback Questionnaire	Other-Survey	New
256225	Columbia Class Program Office 2022 Workforce Survey	Other-Web Survey	New
255866	DISA Hosting and Compute Center (HaCC) Customer Outreach	Other-Screenshots	New
255803	Security Content Automation Protocol (SCAP) Compliance Checker Survey	Other-Web Survey	New
255680	Armed Services Vocational Aptitude Battery (ASVAB) Stakeholder Focus Group Study	Other-Script	New
255635	Mark Center Transportation Management Plan Employee Survey	Other-Survey	New
255612	Soliciting Feedback on U.S. Transportation Command's International Logistics Symposium	Other-Survey	New
255494	JOMIS milSuite Survey	Other-Survey	New
255206	Climate Literacy Pulse Check Questionnaire	Other-Survey	New
254491	DoD Forensics and Biometrics Enterprise Architecture Working Group (FBEAWG) Feedback Survey	Other-Web Survey	New
254370	A&S Communications Survey	Other-Web Survey (Microsoft Forms)	New
254125	Integrated Services Division (ISD) Customer Satisfaction Survey (Kiosk)	Other-Kiosk Screenshot	New
254121	Essence Product Survey	Other-Survey	New
253749	2022 Insider Threat Virtual Conference Survey	Other-Web Survey	New
253712	Customer Experience with Washington Headquarters Services	Other-Survey	New
253686	637th Training Group (TRG)/Defense Language Institute English Language Center (DLIELC) Graduate Survey	Other-Survey	New
253263	HMIRS Feedback Surveys	Other-Web Survey	New
253260	EventPLUS Program Evaluation of the Transition Assistance Program (TAP) and Yellow Ribbon Reintegration Program (YRPP)	Other-Survey	New
253258	BCITS Customer Satisfaction Survey	Other-Survey	New
253257	The Threat Lab/PERSEREC Core Training Evaluation	Other-Survey	New
253251	IPPS-A Customer Support Survey	Other-Web Survey	New
253237	DoD Housing Resident Satisfaction Survey	Other-Survey	New
253235	DLA Supplier Satisfaction Survey	Other-Survey	New
253234	CDSE eLearning End-of-Course Feedback Survey	Other-Web Survey	New
253232	CDSE Webinar Feedback Survey	Other-Web Survey	New
253231	CDSE VILT End-of-Class Feedback Survey	Other-Web Survey	New
253230	CDSE Training Application Survey	Other-Web Survey	New
253229	CDSE Supervisor Training Evaluation Survey	Other-Web Survey	New
253228	CDSE Insider Threat Awareness End-of-Course Feedback	Other-Web Survrey	New
253227	CDSE ILT End-of-Class Feedback Survey	Other-Web Survey	New
253215	$en$e Beta/Summative Testing	Other-Survey	New
253214	DoD Hearing Center of Excellence JHASIR Training Survey	Other-Survey	New
253212	DoD Hearing Center of Excellence Customer Satisfaction Survey	Other-Survey	New
253211	DoDEA Customer Satisfaction Survey - Teachers	Other-Survey	New
253210	DoDEA Customer Satisfaction Survey - Parent/Sponsor	Other-Survey	New
253208	Counseling on Access to Lethal Means (CALM) Annual Survey	Other-Survey	New
253206	DMDC Customer Satisfaction Surveys	Other-Survey	New
253198	Regulations Team Training Course Feedback Survey	Other-Survey	New
253197	DoD Office of Information Management Post-Webinar Survey	Other-Survey	New
253196	DoD Issuance Online Training Feedback	Other-Survey	New
253195	TRICARE Award Fee Provider Survey	Other-Survey	New
253194	Clinical Support Tools Feedback Survey	Other-Survey	New
253193	Military Health System Electronic Health Record End User Survey	Other-Survey	New
253192	DP3 Foundational Course Student Survey	Other-Survey	New
253191	Office of Military Commissions Pulse Survey Privileged Attorney Communication/Work Product	Other-Survey	New
253190	AFN Now Satisfaction Surveys	Other-Survey	New
253189	Executive Health Services Feedback Survey	Other-Survey	New
253188	Pharmacy Program Satisfaction Survey	Other-Survey	New

ICR Details

OMB Control No: 0704-0553	ICR Reference No: 202203-0704-006
Status: Historical Active	Previous ICR Reference No: 201909-0704-011
Agency/Subagency: DOW/DODDEP	Agency Tracking No:
Title: Fast Track 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
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/02/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/29/2022
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the Department must do the following: 1) Unless the DOD 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 DOD is using multiple modes of collection (e.g. paper forms and electronic submissions), the same generic clearance may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using the 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	05/31/2025	36 Months From Approved	04/30/2022
Responses	1,200,000	0	1,200,000
Time Burden (Hours)	300,000	0	300,000
Cost Burden (Dollars)	8,268,000	0	8,268,000

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Abstract: Executive Order 12862 directs Federal agencies to provide service to the public that matches or exceeds the best service available in the private sector. In order to work continuously to ensure that our programs are effective and meet our customers’ needs, the Department of Defense (hereafter “the Agency”) seeks to obtain OMB approval of a generic clearance to collect qualitative feedback on our service delivery. By qualitative feedback we mean information that provides useful insights on perceptions and opinions, but are not statistical surveys that yield quantitative results that can be generalized to the population of study.

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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 67453	11/26/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 17280	03/28/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 131

table that charts list of burden

IC Title	Form No.	Form Name
Integrated Services Division (ISD) Customer Satisfaction Survey (Kiosk)
Military Health System Electronic Health Record End User Survey
$en$e Beta/Summative Testing
2022 Insider Threat Virtual Conference Survey
637th Training Group (TRG)/Defense Language Institute English Language Center (DLIELC) Graduate Survey
637th Training Group Defense Language Institute English Language Center (DLIELC) Post Graduate Survey
A&S Communications Survey
AFN Now Satisfaction Surveys
Accredo TRICARE Specialty Pharmacy Survey
Advana Contractor User Survey
Air Education and Training Command (AETC) Technical Training Management System (TTMS) End of Course Survey
Air Force Combined Mishap Reduction System Surveys for 96 TW & 53 WG
Air University "Final 4" Exit Survey
Air University International Officer School (IOS) Exit Surveys
Air University International Officer School (IOS) Follow-On and Site Surveys
Armed Services Vocational Aptitude Battery (ASVAB) Stakeholder Focus Group Study
BCITS Customer Satisfaction Survey
CATMS Touchpoints Survey
CDAO Agile Adoption Feedback Questionnaire
CDSE ILT End-of-Class Feedback Survey
CDSE Insider Threat Awareness End-of-Course Feedback
CDSE Supervisor Training Evaluation Survey
CDSE Training Application Survey
CDSE VILT End-of-Class Feedback Survey
CDSE Webinar Feedback Survey
CDSE eLearning End-of-Course Feedback Survey
Camp Butler Youth Sports Program Surveys
Climate Literacy Pulse Check Questionnaire
Clinical Support Tools Feedback Survey
Columbia Class Program Office (PMS 397) Professional Growth and Empowerment Event Reaction Survey
Columbia Class Program Office 2022 Workforce Survey
Comment Card for soliciting feedback from people attending the Heartland Band 2023 SOUNDS of the SEASON musical production
Counseling on Access to Lethal Means (CALM) Annual Survey
Customer Experience with Washington Headquarters Services
Customer Feedback on Marine Corps Community Services (MCCS) Food and Beverage Activities
Customer Feedback on the Marine Corps Exchange (MCX) DoD Issued ID Card Scan Pilot
Customer Satisfaction Incentive Surveys
Customer Satisfaction of Military Community Support Programs Services
Customer Satisfaction of Military Community Support Programs Services – MCSP Site Visits
Customer Satisfaction of Military Community Support Programs Services-Military OneSource Call Center Counseling
Customer Satisfaction of Military Community Support Programs Services-Military OneSource Call Center Counseling
Customer Satisfaction of Military Community Support Programs Services-Military OneSource Call Center Special Populations
Customer Satisfaction of Military Community Support Programs Services-Military OneSource Call Center Support Services
Customer Satisfaction of Military OneSource Call Center - Specialty Services
Customer Satisfaction of Military OneSource Call Center - Specialty Services
DAF Applications and A1 Applications Online Feedback Surveys
DAF Community Involvement Plan (CIP) Community Surveys
DHA J-5 Town Hall
DISA Hosting and Compute Center (HaCC) Customer Outreach
DLA Supplier Satisfaction Survey
DMDC Customer Satisfaction Surveys
DOD Survivor Symposium User Feedback Survey
DOD Survivor Symposium User Feedback Survey
DP3 Foundational Course Student Survey
DSCA Regional Center AM&E Program Survey
Department of Defense Domestic Abuse Victim Advocate (DAVA) feedback for the National Organization of Victim Advocates (NOVA) information session
Digital Front Door Virtual Health for Beneficiaries
DoD Forensics and Biometrics Enterprise Architecture Working Group (FBEAWG) Feedback Survey
DoD Hearing Center of Excellence Customer Satisfaction Survey
DoD Hearing Center of Excellence JHASIR Training Survey
DoD Housing Resident Satisfaction Survey
DoD Housing Resident Satisfaction Survey
DoD Issuance Online Training Feedback
DoD Office of Information Management Post-Webinar Survey
DoDEA Customer Satisfaction Survey - Parent/Sponsor
DoDEA Customer Satisfaction Survey - Teachers
Domestic Abuse Victims Advocate Certification and Training Evaluation Plan (PWS 4.3) – DAVA Training Feedback
Enterprise Task Management Software Solution (ETMS2) Training and Customer Satisfaction Survey
Essence Product Survey
EventPLUS Program Evaluation of the Transition Assistance Program (TAP) and Yellow Ribbon Reintegration Program (YRPP)
Executive Health Services Feedback Survey
Fixed Asset Module Implementation Survey
Forensic eXploitation Department Internal Training Feedback Survey
Forensic eXploitation Department Post-Mentorship Feedback Survey
Fresh Meat and Produce Customer Satisfaction Survey
HMIRS Feedback Surveys
Hill AFB Pharmacy Satisfaction Survey
IPPS-A Customer Support Survey
IV Access Patient Survey
JB Charleston EFMP-Family Support Survey
JOMIS milSuite Survey
JPSR Office Hour Survey
Lejeune-New River School Age Care Child Youth Programs Survey
MHS Facilities Design Survey
Marine Corps Community Services (MCCS) Market Assessment Focus Group
Marine Corps Exchange (MCX) Main Store Feedback Survey
Marine Corps Exchange (MCX) Marine Mart Customer Feedback Survey
Marine Corps Recruiting Depot (MCRD) San Diego Spouses Survey for MCFTB Event Planning Improvement
Marine Corps Systems Command (MARCORSYSCOM) Vendor Survey
Mark Center LEED Transportation and Human Experience Survey
Mark Center Transportation Management Plan Employee Survey
Marshall Center Alumni Survey 2002-2022
Matter of Balance Program
MilLife Learning Foresee Feedback Questionnaire
Military Childcare Family User Survey and Program User Survey
Military Community Outreach Feedback Survey
Military Health System Electronic Health Record End User Survey
Military OneSource Call Center Feedback
Military OneSource Triage Experience Survey
NAVSUP FLC Bahrain Foreign Workforce Climate Survey
NSA Candidate Feedback Survey
National Security Space Institute (NSSI) End of Course Survey
Naval Hospital Rota Access to Care Survey
Nurse Advice Line Patient Experience Survey
Office of Military Commissions Pulse Survey Privileged Attorney Communication/Work Product
PEO MLB Voice of the Customer (VoC) Survey
Patient Experience Informal Interviews
Patient Journey Mapping Journals
Patient Navigator Pilot Survey
Pharmacy Patient Satisfaction Survey
Pharmacy Program Satisfaction Survey
Public Health Messaging Survey
Pulse User Feedback Survey
Quarterly Pentagon, Mark Center, and Suffolk Building Parking Survey
Regulations Team Training Course Feedback Survey
Security Content Automation Protocol (SCAP) Compliance Checker Survey
Soliciting Feedback on U.S. Transportation Command's International Logistics Symposium
TRICARE Award Fee Provider Survey
TRICARE.mil and Health.mil Website Satisfaction Surveys
Team Submarine (TSUB) Core Values ACT Campaign Pulse Check Survey
The Threat Lab/PERSEREC Core Training Evaluation
Tier 1, 2 and 3 Helpdesk Customer Satisfaction Feedback Survey
Tinker Air Force Base Provisioning Conference Satisfaction Survey
Tulsa District Boater and Stakeholder Feedback Surveys
USMC Behavioral Programs Standardized Satisfaction Survey
USMC SAPR Services Satisfaction Survey
User feedback from the DOD Survivor Symposium
Voluntary Environmental Cleanup Communication and Outreach Initiative (ECCOI) Community Member Questionnaire
WHS Customer Experience Survey
West Point Band Performance Feedback Survey
dha.mil Website Satisfaction Surveys

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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	1,200,000	1,200,000	0	0	0	0
Annual Time Burden (Hours)	300,000	300,000	0	0	0	0
Annual Cost Burden (Dollars)	8,268,000	8,268,000	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: $741,472

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: 03/29/2022

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