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
Form ODPHP External Cus Customer Satisfaction Survey	Form and Instruction	New	Repair queued
Form 1 WHCHNH General Public Online Viewing Registration	Form	New	Repair queued
Form 1 Informed Consent: DoT Concept Testing	Form and Instruction	Unchanged	Available
Form 1 HRSA Division of Transplantation (DoT) Concept Testing	Form and Instruction	Unchanged	Missing upstream
Form 3 Regional Led Convening Tool Kit	Form and Instruction	Unchanged	Repair queued
Form 1 White House Led Convening Tool Kit	Form and Instruction	Unchanged	Available
Form 2 Partner Led Convenings	Form and Instruction	Unchanged	Available
Form 2 White House Conference on Food, Nutrition, Hunger, and Health listening sessions/convenings and online public comment form.	Form and Instruction	Unchanged	Repair queued
Intranet Survey.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2022-06-17	Repair queued
0090-0379-60-day FRN.docx	Supplementary Document	Uploaded 2020-07-10	Repair queued
2020-14595.pdf	Supplementary Document	Uploaded 2020-07-10	Repair queued
0990-0379 Change Request_DKC.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2015-03-03	Repair queued
0990-0379_B.docx	Supporting Statement B	Uploaded 2014-07-02	Repair queued
0990-0379_Father Generic8-11-20.docx	Supporting Statement A	Uploaded 2020-08-11	Repair queued
Generic Clearance Submission Template.docx	Supplementary Document	Uploaded 2011-06-14	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
260688	Customer Experience in Customer Experience in Funding Opportunity Service Delivery	Other-	New
260302	Listening Sessions with Quality Family Planning (QFP) End Users	Other-Questions for the Listening Sessions	New
260168	Interviews for OPA Quality Family Planning 2.0 Report	Other-Interview Script	New
260011	OPA Grantee Satisfaction Survey 2023	Other-survey with instructions	New
259214	: Office of the Assistant Secretary for Health Office of Disease Prevention and Health Promotion External Customer Satisfaction Survey	Form and Instruction	New	Customer Satisfaction Survey
256799	Covid.gov - On Page - All Devices	Other-survey	New
256517	Department of Health and Human Services/ Assistant Secretary for Public Affairs/ Email Marketing Subscriber Survey	Other-survey	New
255940	Generic Clearance for the Collection of Routine Customer Feedback" ODPHP Online Customer Surveys	Other-ODPHP Website Screener	New
255611	White House Conference on Hunger, Nutrition and Health General Public Online Conference Registration form	Form	New	WHCHNH General Public Online Viewing Registration
254466	Usability Testing for HRSA.gov website properties	Instruction	New
254400	Pre & post-program survey questions for OMH Minority Leadership Development Program	Other-HHS Host-site pre-program questionnaire	New
254221	HRSA Division of Transplantation (DoT) Concept Testing	Form and Instruction	Unchanged	Informed Consent: DoT Concept Testing
254221	HRSA Division of Transplantation (DoT) Concept Testing	Form and Instruction	Unchanged
254221	HRSA Division of Transplantation (DoT) Concept Testing	Instruction	Unchanged
254087	TPP20 Tier 1 and Tier 2 Grantee Informational Form	Other-Survey	Unchanged
253316	White House Conference on Food, Nutrition, Hunger, and Health listening sessions/convenings and online public comment form.	Form and Instruction	Unchanged	Regional Led Convening Tool Kit
253316	White House Conference on Food, Nutrition, Hunger, and Health listening sessions/convenings and online public comment form.	Form and Instruction	Unchanged	White House Led Convening Tool Kit
253316	White House Conference on Food, Nutrition, Hunger, and Health listening sessions/convenings and online public comment form.	Form and Instruction	Unchanged	Partner Led Convenings
253316	White House Conference on Food, Nutrition, Hunger, and Health listening sessions/convenings and online public comment form.	Form and Instruction	Unchanged
253036	Tree Testing of Funding Section on HRSA.gov	Instruction	Unchanged
252998	Tree Testing of HRSA's MCHB Website	Instruction	Unchanged
252633	TPP Performance measures Technical Assistance Survey	Other-survey script instructions and reminder emails	Unchanged
252396	Focus Group Feedback OPA Adolescent Health Strategic Plan	Other-Focus Group Questions	Unchanged
252391	Interviews for OPA Adolescent Health National Strategic Plan Development	Other-structured interview guide	Unchanged
252239	Office of Population Affairs Grantee Satisfaction Survey 2022	Other-survey with instructions	Unchanged
251908	Key Informant Impact and Gap Feedback Tool - 2021 California Wildfires Disaster	Other-	Unchanged
251266	Customer Feedback on Previously Developed Health Messaging to Promote Vaccination Among Older African American Community Health Workers	Other-Questionnaire	Unchanged
248927	Intranet Customers Feedback	Other-FT Generic Survey	Modified
248813	ASPR Listening Sessions	Other-Registration Form	Unchanged
248522	ASPR Candidate Experience Survey	Other-survey	Unchanged
248369	OMH WEBINAR PROMISING PROGRAMS AND PRACTICES ASSESSMENTS	Other-webinar	Unchanged
248263	TPP Network grantee technical assistance survey	Other-survey and instructions	Unchanged
246920	Office of Population Affairs (OPA) 2021 Annual Grantee Satisfaction Survey	Other-survey and instruction	Unchanged
246659	Office of the Assistant Secretary for Health (OASH) Office of Regional Health Operations (ORHO) External Customer Satisfaction Survey	Other-survey	Unchanged
246466	Bureau of Health Workforce (BHW) Website Usability Testing	Other-Test Script instrument	Unchanged
246463	National Hypertension Control Initiative (NHCI) Community Health Center Assessment	Other-test script	Unchanged
245995	HHS.gov Continuous Improvement Survey	Other-survey	Unchanged
245932	Federal Office of Rural Health Policy (FORHP) Website Card Sort	Other-card sort script	Unchanged
245888	COVID-19 VIRTUAL LEARNING SESSIONS FEEDBACK ASSESSMENT	Other-learning session	Unchanged
245749	HRSA HIV/AIDS Bureau (HAB) Website Card Sort	Other-HAB cart test script	Unchanged
245748	Maternal and Child Health Bureau (MCHB) Website Card Sort	Other-MCHB card test script	Unchanged
245430	Bureau of Primary Health Care (BPHC) Website Card Sort	Other-Survey-test script	Unchanged
244597	Teen Pregnancy Prevention (TPP) Evaluation Technical Assistance: Satisfaction Survey for Group TA Activities	Other-survey and instructions	Unchanged
244596	Teen Pregnancy Prevention (TPP) Evaluation Technical Assistance Product Satisfaction Feedback Survey	Other-survey and instructions	Unchanged
244370	User feedback for the Benefit Cliff Calculator	Other-Survey	Unchanged
244171	www.medicalcountermeasures.gov customer site feedback form	Other-question	Unchanged
243723	Office of Population Affairs (OPA) Training and Technical Assistance (T/TA) Satisfaction Survey	Other-survey and instructions	Unchanged
243333	ADVANCING THE RESPONSE TO COVID-19: SHARING PROMISING PROGRAMS AND PRACTICES FOR RACIAL AND ETHNIC MINORITY COMMUNITIES VIRTUAL SYMPOSIUM WEBINAR ASSESSMENT	Other-Survey	Unchanged
243178	Office of Population Affairs (OPA) Title X Family Planning Annual Reporting (FPAR) 2.0 Grantee Readiness Survey	Other-survey and script	Unchanged

ICR Details

OMB Control No: 0990-0379	ICR Reference No: 202206-0990-003
Status: Historical Active	Previous ICR Reference No: 202007-0990-001
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/24/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/23/2022
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the 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	08/31/2023	08/31/2023	08/31/2023
Responses	420,000	0	420,000
Time Burden (Hours)	70,000	0	70,000
Cost Burden (Dollars)	0	0	0

---

Abstract: This collection of information is necessary to enable HHS 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 HHS programs.

---

Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  

Citations for New Statutory Requirements: None

---

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:
	85 FR 26485	05/04/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 41056	07/08/2020
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 44

table that charts list of burden

IC Title	Form No.	Form Name
Bureau of Primary Health Care (BPHC) Website Card Sort
Listening Sessions with Quality Family Planning (QFP) End Users
: Office of the Assistant Secretary for Health Office of Disease Prevention and Health Promotion External Customer Satisfaction Survey	ODPHP External Customer Satisfaction Survey	Customer Satisfaction Survey
ADVANCING THE RESPONSE TO COVID-19: SHARING PROMISING PROGRAMS AND PRACTICES FOR RACIAL AND ETHNIC MINORITY COMMUNITIES VIRTUAL SYMPOSIUM WEBINAR ASSESSMENT
ASPR Candidate Experience Survey
ASPR Listening Sessions
Bureau of Health Workforce (BHW) Website Usability Testing
COVID-19 VIRTUAL LEARNING SESSIONS FEEDBACK ASSESSMENT
Covid.gov - On Page - All Devices
Customer Experience in Customer Experience in Funding Opportunity Service Delivery
Customer Feedback on Previously Developed Health Messaging to Promote Vaccination Among Older African American Community Health Workers
Department of Health and Human Services/ Assistant Secretary for Public Affairs/ Email Marketing Subscriber Survey
Federal Office of Rural Health Policy (FORHP) Website Card Sort
Focus Group Feedback OPA Adolescent Health Strategic Plan
Generic Clearance for the Collection of Routine Customer Feedback" ODPHP Online Customer Surveys
HHS.gov Continuous Improvement Survey
HRSA Division of Transplantation (DoT) Concept Testing	1	Informed Consent: DoT Concept Testing
HRSA HIV/AIDS Bureau (HAB) Website Card Sort
Interviews for OPA Adolescent Health National Strategic Plan Development
Interviews for OPA Quality Family Planning 2.0 Report
Intranet Customers Feedback
Key Informant Impact and Gap Feedback Tool - 2021 California Wildfires Disaster
Maternal and Child Health Bureau (MCHB) Website Card Sort
National Hypertension Control Initiative (NHCI) Community Health Center Assessment
OMH WEBINAR PROMISING PROGRAMS AND PRACTICES ASSESSMENTS
OPA Grantee Satisfaction Survey 2023
Office of Population Affairs (OPA) 2021 Annual Grantee Satisfaction Survey
Office of Population Affairs (OPA) Title X Family Planning Annual Reporting (FPAR) 2.0 Grantee Readiness Survey
Office of Population Affairs (OPA) Training and Technical Assistance (T/TA) Satisfaction Survey
Office of Population Affairs Grantee Satisfaction Survey 2022
Office of the Assistant Secretary for Health (OASH) Office of Regional Health Operations (ORHO) External Customer Satisfaction Survey
Pre & post-program survey questions for OMH Minority Leadership Development Program
TPP Network grantee technical assistance survey
TPP Performance measures Technical Assistance Survey
TPP20 Tier 1 and Tier 2 Grantee Informational Form
Teen Pregnancy Prevention (TPP) Evaluation Technical Assistance Product Satisfaction Feedback Survey
Teen Pregnancy Prevention (TPP) Evaluation Technical Assistance: Satisfaction Survey for Group TA Activities
Tree Testing of Funding Section on HRSA.gov
Tree Testing of HRSA's MCHB Website
Usability Testing for HRSA.gov website properties
User feedback for the Benefit Cliff Calculator
White House Conference on Food, Nutrition, Hunger, and Health listening sessions/convenings and online public comment form.	2, 1, 3	Partner Led Convenings ,   White House Led Convening Tool Kit ,   Regional Led Convening Tool Kit
White House Conference on Hunger, Nutrition and Health General Public Online Conference Registration form	1	WHCHNH General Public Online Viewing Registration
www.medicalcountermeasures.gov customer site feedback form

---

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	420,000	420,000	0	0	0	0
Annual Time Burden (Hours)	70,000	70,000	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:

---

Annual Cost to Federal Government: $300,000

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

---

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: 06/23/2022

---