Fast Track Generic Clearance for the Collection of Routine Customer Feedback memo

Request for Approval under the “Fast Track Generic Clearance for the Collection of Routine Customer Feedback” HHS Online Customer Surveys (OMB Control Number: 0990-0459)

TITLE OF INFORMATION COLLECTION: User feedback for the Climate and Health Outlook

PURPOSE:  The HHS Office of Climate Change and Health Equity produces a monthly Climate and Health Outlook (CHO). The purpose of the CHO is to provide health professionals, state and local health officials, planners, and the public with the information necessary to plan for the health impacts of climate change and extreme weather events with 30-90 day forecasts. The purpose of collecting feedback from users of the CHO is to better understand whether users find the tool to be easy to use, and whether the information provided by the tool is helpful for health systems, state and local health/planning officials, and household decision-making. The purpose of the tool is to provide users with useful information, so the ease of use and helpfulness of the information provided by the tool is critical to help users make informed decisions about preparing for and responding to the health impacts of climate change and extreme weather events.

DESCRIPTION OF RESPONDENTS: The CHO is sent out in a regular newsletter and is also available through the OCCHE website. Therefore, targeted respondents will be residents of United States and the health system organizations that receive the newsletter. Individuals and organizations receiving this information will be able to use it to anticipate climate change and extreme weather events. Respondents will first use the CHO, then, at the conclusion of using the Calculator, respond to user feedback items.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [x] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[] Focus Group [ ] Other: ______________________

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.

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.

Name:__Ashley Sanders-Jackson______________________________________________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [x ] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No X NOT APPLICABLE

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ ] No NOT APPLICABLE

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [ X] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden hour
Private citizens	200	5/60	16.665
Health Organization (HO) and Health Providers	200	5/60	16.665
Totals	400		33.33

Please note that the survey contains 4 items for respondents who are benefit recipients and 5 items for respondents who are caseworkers, for a total of 9 items. However, all respondents will only answer 4 or 5 items (no respondent will answer all 9 items).

FEDERAL COST: The estimated annual cost to the Federal government is _$10,000___________

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [ ] Yes [ x] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

The Calculator will reside on a public-facing website, so any individual with internet access will be able to access the Calculator.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[x ] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [x ] No

Please make sure that all instruments, instructions, and scripts are submitted with the request.

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