Circular A-11 Sec 280_ ICR Template Under Touchpoints Survey Tool Generic

Individual Information Collection Request

Under GSA’s Generic Clearance: Improving Customer Experience - Implementation of Section 280 of OMB Circular A-11

OMB Control No. 3090-XXXX

OVERVIEW

1. GSA will be administering this collection on behalf of the following approved Department-level organization:

Department of Agriculture, Department of Commerce, Department of Defense, Department of Education, Department of Energy, Department of Health and Human Services, Department of Homeland Security Department of Housing and Urban Development, Department of the Interior, Department of Justice, Department of Labor Department of State, United States Agency for International Development, the General Services Administration, Department of Transportation, Department of the Treasury, Department of Veterans Affairs, Environmental Protection Agency, National Aeronautics and Space Administration, the Consumer Financial Protection Bureau, National Science Foundation, Nuclear Regulatory Commission, the Small Business Administration, the Office of Personnel Management, and Social Security Administration

1. Additional sub component, office, program:

2. Agency POC name:

3. Agency POC email:

4. Description of service Touchpoint is measuring:

5. Point of service at which the Touchpoint survey is presented:

6. Method by which the Touchpoint survey is presented:

   • [X] Web-based: pop-up on webpage while a user is browsing

   • [ ] Web-based: embedded into webpage

   • [ ] Email: With link to click and submit

   • [ ] In-person: At a computer or tablet kiosk

   • [ ] Mail

   • [ ] Other, Explain

7. Description of respondents:

   • Do you have a customer list or something similar that defines the universe of potential respondents?

   • Will the survey be presented to all potential customers that interact at the point described in #5, or is there a sampling plan from selecting from this universe? If a sampling plan, describe that here.

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 other than in format and process described in the umbrella generic clearance.

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.

7. The questions and other survey details are in line with the Supporting Statements of this clearance.

Name (Touchpoints Manager supporting this collection): ________________________________________________

BURDEN HOURS:

Category of Respondent	No. of Respondents	Participation Time	Burden Hours
Totals

FEDERAL COST:

If any costs are associated with this collection beyond the Agency and Touchpoints staff time spent developing the survey and technical operating costs of Touchpoints, please describe and calculate these here:

QUESTIONS:

Please include all questions and response options (either multiple choice options or free text fields, etc.):

SCREENSHOTS:

ADMINISTRATION DETAILS:

The following will be displayed on this Touchpoints survey:

OMB Control No. 0690-0030, Expiration Date: XX/XX/XXXX