Electronic Survey for Soliciting Feedback for the Heat Illness Prevention Campaign Newsletter

Request for Approval under the “Generic Clearance for Improving Customer Experience: OMB Circular A-11, Section 280 Implementation”

(OMB Control Number: 1225-0093)

TITLE OF INFORMATION COLLECTION: Electronic Survey for Soliciting Feedback for the Heat Illness Prevention Campaign Newsletter

PURPOSE OF COLLECTION: Electronic survey designed to gather feedback from stakeholders who are interested in receiving the “Heat Source,” a newsletter with information on heat illness prevention. Soliciting feedback on how stakeholders perceive the current heat materials, how well we serve our stakeholders in this area, and identify areas for improvement particularly around the areas of diversity, equity, inclusion, and accessibility. We plan to use the feedback to improve the experience and resources for all different types of stakeholders.

TYPE OF ACTIVITY: (Check one)

[ ] Customer Research (Interview, Focus Groups)

[ X ] Customer Feedback Survey

[ ] User Testing

ACTIVITY DETAILS

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

[ ] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ X ] Other, Explain

Information will be collected when individuals sign up for a heat newsletter via Granicus/GovDelivery.

2. Who will you collect the information from?

DSG will collect the information from stakeholders interested in receiving updates and resources on health illness prevention from the heat newsletter in GovDelivery. These stakeholders may include but are not limited to workers, employers, safety and health professionals, etc.

3. How will you ask a respondent to provide this information?

Individuals will be prompted to answer the questions as they register to receive the heat newsletter in GovDelivery. Questions will be optional.

4. What will the activity look like?

Individuals interested in receiving a heat illness prevention newsletter via GovDelivery will enter their email address. Individuals will also be prompted to answer questions. The questionnaire will explain the purpose of the collection and will have seven questions.

The optional questionnaire will pop up on the screen for participants and will include an explanation of the purpose of the collection and a survey with seven questions. Two of the questions are single answer selection while the remaining five allow for multiple selection.

5. Please provide your question list.

Please see attached

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

Script/prompt language attached.

6. When will the activity happen?

DSG will set up the questionnaire upon approval, likely beginning in Summer 2022 when new heat materials are released for the newsletter.

7. 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 (in hours)	Burden Hours
Listserv Respondents	10,000	3/60	500
Totals	10,000		500

CERTIFICATION:

I certify the following to be true:

1. The collections are voluntary;

2. The collections are low-burden for respondents (based on considerations of total burden hours or burden-hours per respondent) and are low-cost for both the respondents and the Federal Government;

3. The collections are non-controversial and do not raise issues of concern to other Federal agencies;

4. Any 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 near future;

5. Personally identifiable information (PII) is collected only to the extent necessary and is not retained;

6. Information gathered is intended to be used for general service improvement and program management purposes

7. Upon agreement between OMB and the agency aggregated data may be released as part of A-11, Section 280 requirements only on performance.gov. Summaries of customer research and user testing activities may be included in public-facing customer journey maps.

8. Additional release of data will be coordinated with OMB.

Name:

All instruments used to collect information must include:

OMB Control No. 1225-0093

Expiration Date:

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