Generic Clearance for Improving Customer Experience: OMB Circular A–11, Section 280 Implementation) (CMS-10710)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10970 Medicare Advantage Beneficiary Customer Satisfaction Survey for Complaint Resolution	Form and Instruction	New	Repair queued
Form CMS-10966 Proposed Qualtrics Survey Script	Form and Instruction	New	Repair queued
Form CMS-10909 Medicaid.gov Pop-up Survey	Form and Instruction	New	Repair queued
Form CMS-10903 Consent form	Form and Instruction	New	Repair queued
Form CMS-10903 Caregiver Eligibility Screener	Form and Instruction	New	Repair queued
Form CMS-10903 Generative In-Depth Interview Guide	Form and Instruction	New	Repair queued
Form CMS-10962 CMS-10962. SPANISH_FLH Page Form Survey	Form and Instruction	New	Repair queued
Form CMS_10962 CMS-10962.ENGLISH FLH Page Form Survey	Form and Instruction	New	Repair queued
Form CMS-10911 Medicaid.gov Static Feedback Tool	Form and Instruction	New	Repair queued
Form CMS-10910 Insure Kids Now Pop-up Survey	Form and Instruction	New	Repair queued
Form CMS-10710.GenIC#15 GenIC #15-TRIPTK JourneyAI Survey Medical Professionals	Form and Instruction	New	Repair queued
Form CMS-10710.GenIC#14 GenIC#14-TRIPTK - JourneyAI Survey_Beneficiaries & Caregivers.docx	Form and Instruction	New	Repair queued
Form CMS-10710 CMS-10710.[Medicare Research GenIC#14-TRIPTK] JourneyAI Survey_Beneficiaries & Caregivers	Form and Instruction	New	Repair queued
Form CMS-10710 CMS-10710.[Medicare Research GenIC#13-TRIPTK] Homework_Journey Map	Form and Instruction	New	Repair queued
Form CMS-10710 CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_UX Task & Talk	Form and Instruction	New	Repair queued
Form CMS-10710 CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_Round Table_Caregivers	Form and Instruction	New	Repair queued
Form CMS-10710 CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_Round Table_Beneficiaries.docx	Form and Instruction	New	Repair queued
Form CMS-10710 CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_IDI In-Home DYADs Caregivers and Beneficiaries	Form and Instruction	New	Repair queued
Form CMS-10710 CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_IDI In-Home & Facility_Beneficiaries	Form and Instruction	New	Repair queued
Form CMS-10710#12 CMS-10710.GenIC#12 - DACA - Instrument	Form and Instruction	New	Repair queued
Form CMS-10911 Medicaid.gov Always On Feedback Survey	Form	New	Repair queued
Form CMS-10911 Medicaid.gov Feedback Survey	Form and Instruction	New	Repair queued
Form CMS-10910 Insure Kids Now Customer Feedback Survey	Form and Instruction	New	Repair queued
Form CMS-10909 Medicaid.gov Customer Feedback Survey	Form and Instruction	New	Repair queued
Form CMS-10900 CMS-10900.Applicant Screener Survey (7-9-24)	Form and Instruction	New	Repair queued
Form CMS-10710.GenIC#11 CMS-10710 GenIC#11. (CMS 10868) Change of Status Instrument	Form and Instruction	New	Repair queued
Form CMS-10003 Notice of Denial of Medical Coverage	Form and Instruction	New	Repair queued
Form CMS-10003 Notice Testing Guide	Form and Instruction	New	Repair queued
Form CMS-10146 Notice of Denial of Medicare Part D Drug Coverage	Form and Instruction	New	Repair queued
Form CMS-10146 Notice Testing Guide	Form and Instruction	New	Repair queued
Form CMS-10710.GenIC#4 Healhtcare.gov Web Satisfaction Survey (Instrument)	Form and Instruction	New	Available
Form CMS-10710.GenIC #8 High Impact Trust Survey Medicare (Instrument)	Form and Instruction	New	Available
Form CMS-10710.GenIc#7 CMS-10710#7 - Medicare IVR Customer Sat Survey (A11 Section 280) (30-day)	Form and Instruction	Unchanged	Available
Form CMS-10710.GenIc#7 CMS-10710.GenIC#7 - Medicare IVR Customer Sat Survey (A11 Section 280) (30-day)	Form and Instruction	Unchanged	Available
Form CMS-10710.GenIC#6 CMS-10710.GenIC#6 - Marketplace IVR Customer Sat Survey (A11 Section 280) (30-day)	Form and Instruction	Unchanged	Available
Form CMS-10710.GenIC#6 CMS-10710.GenIC #6 - Marketplace IVR Customer Sat Survey (A11 Section 280)	Form and Instruction	Unchanged	Repair queued
Form CMS-10710.GenIC#5 CMS-10710#5 - Medicare.gov Web Sat Survey (A11 Section 280)	Form and Instruction	Unchanged	Available
Form CMS-10710.GenIC#5 CMS-10710.GenIC#5 - Medicare.gov Web Sat Survey (A11 Section 280)	Form and Instruction	Unchanged	Repair queued
Form CMS-10710.GenIC#4 CMS-10710.GenIC#4 - Healthcare.gov_Web_Sat_Survey (A11 Section 280)	Form and Instruction	Unchanged	Available
Form CMS-10710.GenIC#4 CMS-10710.GenIC#4 - Healthcare.gov Web Satisfaction Survey (A11 Section 280)	Form and Instruction	Unchanged	Repair queued
0938-1382.Justification of Non-sub Change (Technical Correction)-2-29-24.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-02-29	Available
0938-1382.Justification of Non-sub Change (Technical Correction)-2-29-24.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-02-29	Repair queued
0938-1382.Justification of Non-sub Change (Burden Ceiling Increase)-2-20-24.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-02-20	Available
0938-1382.Justification of Non-sub Change (Burden Ceiling Increase)-2-20-24.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-02-20	Repair queued
ICR Template_A11 Section 280 Clearance.docx	Supplementary Document	Uploaded 2023-11-21	Available
ICR Template_A11 Section 280 Clearance.docx	Supplementary Document	Uploaded 2023-11-21	Repair queued
CMS-10710.SupportingStatementPartA (revised final).docx	Supporting Statement A	Uploaded 2023-11-21	Available
CMS-10710.SupportingStatementPartA (revised final).docx	Supporting Statement A	Uploaded 2023-11-21	Repair queued
CMS-10710.SupportingStatementPartB (30-day).docx	Supporting Statement B	Uploaded 2023-09-30	Available
CMS-10710.SupportingStatementPartB (30-day).docx	Supporting Statement B	Uploaded 2023-09-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
281004	Medicare Advantage Beneficiary Customer Satisfaction Survey for Complaint Resolution (CMS-10970)	Form and Instruction	New	Medicare Advantage Beneficiary Customer Satisfaction Survey for Complaint Resolution
280700	Salesforce Customer Relationship Management Satisfaction Survey (CMS-10966)	Form and Instruction	New	Proposed Qualtrics Survey Script
280632	[Medicaid] CMS-10909 (Revision): Medicaid.gov Pop-up Survey	Form and Instruction	New	Medicaid.gov Pop-up Survey
280485	Foundational Generative In-Depth Interviews for Identifying Needs and Challenges of Adult Caregivers' on Issues Related to Access, Technology, Privacy and Data sharing (CMS-10903)	Form and Instruction	New	Consent form
280485	Foundational Generative In-Depth Interviews for Identifying Needs and Challenges of Adult Caregivers' on Issues Related to Access, Technology, Privacy and Data sharing (CMS-10903)	Form and Instruction	New	Caregiver Eligibility Screener
280485	Foundational Generative In-Depth Interviews for Identifying Needs and Challenges of Adult Caregivers' on Issues Related to Access, Technology, Privacy and Data sharing (CMS-10903)	Form and Instruction	New	Generative In-Depth Interview Guide
280410	Website Page Feedback Form: Find Local Help on https://www.healthcare.gov (CMS-10962)	Form and Instruction	New	CMS-10962. SPANISH_FLH Page Form Survey
280410	Website Page Feedback Form: Find Local Help on https://www.healthcare.gov (CMS-10962)	Form and Instruction	New	CMS-10962.ENGLISH FLH Page Form Survey
280043	[Medicaid] CMS-10911 (Revision): Medicaid.gov Static Feedback	Form and Instruction	New	Medicaid.gov Static Feedback Tool
280042	[Medicaid] CMS-10910 (Revision): Insure Kids Now Pop-up Survey	Form and Instruction	New	Insure Kids Now Pop-up Survey
278412	(REVISED) CMS-10710. GenIC#15 – TRIPTK- Journey AI Survey - Medical Professionals	Form and Instruction	New	GenIC #15-TRIPTK JourneyAI Survey Medical Professionals
278379	GenIC#14 – TRIPTK- Journey AI Surveys Beneficiaries and Caregivers	Form and Instruction	New	GenIC#14-TRIPTK - JourneyAI Survey_Beneficiaries & Caregivers.docx
278282	CMS-10710. GenIC#15 – TRIPTK- Journey AI Survey - Professionals	Form and Instruction	New	CMS-10710.[Medicare Research GenIC#14-TRIPTK] JourneyAI Survey_Beneficiaries & Caregivers
278279	CMS-10710. GenIC#13 - TRIPTK	Form and Instruction	New	CMS-10710.[Medicare Research GenIC#13-TRIPTK] Homework_Journey Map
278279	CMS-10710. GenIC#13 - TRIPTK	Form and Instruction	New	CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_UX Task & Talk
278279	CMS-10710. GenIC#13 - TRIPTK	Form and Instruction	New	CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_Round Table_Caregivers
278279	CMS-10710. GenIC#13 - TRIPTK	Form and Instruction	New	CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_Round Table_Beneficiaries.docx
278279	CMS-10710. GenIC#13 - TRIPTK	Form and Instruction	New	CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_IDI In-Home DYADs Caregivers and Beneficiaries
278279	CMS-10710. GenIC#13 - TRIPTK	Form and Instruction	New	CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_IDI In-Home & Facility_Beneficiaries
271246	GenIC #12 – Usability and Cognitive Testing: HC.gov Application Enhancements for DACA Recipients	Form and Instruction	New	CMS-10710.GenIC#12 - DACA - Instrument
270190	[Medicaid] Medicaid.gov Feedback Survey (CMS-10911)	Form	New	Medicaid.gov Always On Feedback Survey
270190	[Medicaid] Medicaid.gov Feedback Survey (CMS-10911)	Form and Instruction	New	Medicaid.gov Feedback Survey
270189	[Medicaid] Insure Kids Now Customer Feedback Survey (CMS-10910)	Form and Instruction	New	Insure Kids Now Customer Feedback Survey
270188	[Medicaid] Medicaid.gov Customer Feedback Survey (CMS-10909)	Form and Instruction	New	Medicaid.gov Customer Feedback Survey
269319	Facing Financial Shock Applicant Recruitment Survey (CMS-10900)	Form and Instruction	New	CMS-10900.Applicant Screener Survey (7-9-24)
269259	GenIC #11 - Notice Testing: CMS Notice of Change of Status (CMS-10868)	Form and Instruction	New	CMS-10710 GenIC#11. (CMS 10868) Change of Status Instrument
267346	CMS-10710.GenIC#10.- Notice Testing: CMS Notice of Denial of Medical Coverage (CMS-10003)	Form and Instruction	New	Notice of Denial of Medical Coverage
267346	CMS-10710.GenIC#10.- Notice Testing: CMS Notice of Denial of Medical Coverage (CMS-10003)	Form and Instruction	New	Notice Testing Guide
267345	CMS-10710. GenIC #9 - Notice Testing: CMS Notice of Denial of Part D Drug Coverage (CMS-10146)	Form and Instruction	New	Notice of Denial of Medicare Part D Drug Coverage
267345	CMS-10710. GenIC #9 - Notice Testing: CMS Notice of Denial of Part D Drug Coverage (CMS-10146)	Form and Instruction	New	Notice Testing Guide
265831	CMS-10710.GenIC#4 - Healthcare.gov Web Satisfaction Survey (REVISON)	Form and Instruction	New	Healhtcare.gov Web Satisfaction Survey (Instrument)
265830	CMS-10710.GenIC#8 - High Impact Trust Survey Medicare	Form and Instruction	New	High Impact Trust Survey Medicare (Instrument)
262622	CMS-10710.GenIC#7 - Medicare IVR Customer Sat Survey (A11 Section 280) (30-day)	Form and Instruction	Unchanged	CMS-10710#7 - Medicare IVR Customer Sat Survey (A11 Section 280) (30-day)
262622	CMS-10710.GenIC#7 - Medicare IVR Customer Sat Survey (A11 Section 280) (30-day)	Form and Instruction	Unchanged
262621	CMS-10710.GenIC #6 - Marketplace IVR Customer Sat Survey (A11 Section 280)	Form and Instruction	Unchanged	CMS-10710.GenIC#6 - Marketplace IVR Customer Sat Survey (A11 Section 280) (30-day)
262621	CMS-10710.GenIC #6 - Marketplace IVR Customer Sat Survey (A11 Section 280)	Form and Instruction	Unchanged
262620	CMS-10710.GenIC#5 - Medicare.gov Web Sat Survey (A11 Section 280)	Form and Instruction	Unchanged	CMS-10710#5 - Medicare.gov Web Sat Survey (A11 Section 280)
262620	CMS-10710.GenIC#5 - Medicare.gov Web Sat Survey (A11 Section 280)	Form and Instruction	Unchanged
262619	CMS-10710.GenIC#4 - Healthcare.gov Web Satisfaction Survey (A11 Section 280)	Form and Instruction	Unchanged	CMS-10710.GenIC#4 - Healthcare.gov_Web_Sat_Survey (A11 Section 280)
262619	CMS-10710.GenIC#4 - Healthcare.gov Web Satisfaction Survey (A11 Section 280)	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0938-1382	ICR Reference No: 202402-0938-008
Status: Active	Previous ICR Reference No: 202402-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: OC
Title: Generic Clearance for Improving Customer Experience: OMB Circular A–11, Section 280 Implementation) (CMS-10710)
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: 03/01/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/29/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2026	12/31/2026	12/31/2026
Responses	1,001,750	0	1,001,750
Time Burden (Hours)	154,433	0	133,933
Cost Burden (Dollars)	0	0	0

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Abstract: In March 2018, the Administration of President Trump launched the President’s Management Agenda (PMA) and established new Cross-Agency Priority (CAP) Goals. Excellent service was established as a core component of the mission, service, stewardship model that frames the entire PMA, embedding a customer-focused approach in all of the PMA’s initiatives. This model was also included in the 2018 update of the Federal Performance Framework in Circular A-11, ensuring ‘excellent service’ as a focus in future agency strategic planning efforts. The PMA included a CAP Goal on Improving Customer Experience with Federal Services, with a primary strategy to drive improvements within 25 of the nation’s highest impact programs. This effort is supported by an interagency team and guidance in Circular A-11 requiring the collection of customer feedback data and increasing the use of industry best practices to conduct customer research. These Presidential actions and requirements establish an ongoing process of collecting customer insights and using them to improve services. This new request will enable the Centers for Medicare and Medicaid Services (hereafter the Agency) to act in accordance with OMB Circular A-11 Section 280 to ultimately transform the experience of its customers to improve both efficiency and mission delivery, and increase accountability by communicating about these efforts with the public.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: 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:
	88 FR 47881	07/25/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 67299	09/29/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 25

table that charts list of burden

IC Title	Form No.	Form Name
(REVISED) CMS-10710. GenIC#15 – TRIPTK- Journey AI Survey - Medical Professionals	CMS-10710.GenIC#15	GenIC #15-TRIPTK JourneyAI Survey Medical Professionals
CMS-10710. GenIC #9 - Notice Testing: CMS Notice of Denial of Part D Drug Coverage (CMS-10146)	CMS-10146, CMS-10146	Notice Testing Guide ,   Notice of Denial of Medicare Part D Drug Coverage
CMS-10710. GenIC#13 - TRIPTK	CMS-10710, CMS-10710, CMS-10710, CMS-10710, CMS-10710, CMS-10710	CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_IDI In-Home & Facility_Beneficiaries ,   CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_IDI In-Home DYADs Caregivers and Beneficiaries ,   CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_Round Table_Beneficiaries.docx ,   CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_Round Table_Caregivers ,   CMS-10710. [Medicare Research GenIC#13-TRIPTK] Discussion Guide_UX Task & Talk ,   CMS-10710.[Medicare Research GenIC#13-TRIPTK] Homework_Journey Map
CMS-10710. GenIC#15 – TRIPTK- Journey AI Survey - Professionals	CMS-10710	CMS-10710.[Medicare Research GenIC#14-TRIPTK] JourneyAI Survey_Beneficiaries & Caregivers
CMS-10710.GenIC #6 - Marketplace IVR Customer Sat Survey (A11 Section 280)	CMS-10710.GenIC#6	CMS-10710.GenIC#6 - Marketplace IVR Customer Sat Survey (A11 Section 280) (30-day)
CMS-10710.GenIC#10.- Notice Testing: CMS Notice of Denial of Medical Coverage (CMS-10003)	CMS-10003, CMS-10003	Notice Testing Guide ,   Notice of Denial of Medical Coverage
CMS-10710.GenIC#4 - Healthcare.gov Web Satisfaction Survey (A11 Section 280)	CMS-10710.GenIC#4	CMS-10710.GenIC#4 - Healthcare.gov_Web_Sat_Survey (A11 Section 280)
CMS-10710.GenIC#4 - Healthcare.gov Web Satisfaction Survey (REVISON)	CMS-10710.GenIC#4 (REVISION)	Healhtcare.gov Web Satisfaction Survey (Instrument)
CMS-10710.GenIC#5 - Medicare.gov Web Sat Survey (A11 Section 280)	CMS-10710.GenIC#5	CMS-10710#5 - Medicare.gov Web Sat Survey (A11 Section 280)
CMS-10710.GenIC#7 - Medicare IVR Customer Sat Survey (A11 Section 280) (30-day)	CMS-10710.GenIc#7	CMS-10710#7 - Medicare IVR Customer Sat Survey (A11 Section 280) (30-day)
CMS-10710.GenIC#8 - High Impact Trust Survey Medicare	CMS-10710.GenIC #8	High Impact Trust Survey Medicare (Instrument)
Facing Financial Shock Applicant Recruitment Survey (CMS-10900)	CMS-10900	CMS-10900.Applicant Screener Survey (7-9-24)
Foundational Generative In-Depth Interviews for Identifying Needs and Challenges of Adult Caregivers' on Issues Related to Access, Technology, Privacy and Data sharing (CMS-10903)	CMS-10903, CMS-10903, CMS-10903	Generative In-Depth Interview Guide ,   Caregiver Eligibility Screener ,   Consent form
GenIC #11 - Notice Testing: CMS Notice of Change of Status (CMS-10868)	CMS-10710.GenIC#11	CMS-10710 GenIC#11. (CMS 10868) Change of Status Instrument
GenIC #12 – Usability and Cognitive Testing: HC.gov Application Enhancements for DACA Recipients	CMS-10710#12	CMS-10710.GenIC#12 - DACA - Instrument
GenIC#14 – TRIPTK- Journey AI Surveys Beneficiaries and Caregivers	CMS-10710.GenIC#14	GenIC#14-TRIPTK - JourneyAI Survey_Beneficiaries & Caregivers.docx
Medicare Advantage Beneficiary Customer Satisfaction Survey for Complaint Resolution (CMS-10970)	CMS-10970	Medicare Advantage Beneficiary Customer Satisfaction Survey for Complaint Resolution
Salesforce Customer Relationship Management Satisfaction Survey (CMS-10966)	CMS-10966	Proposed Qualtrics Survey Script
Website Page Feedback Form: Find Local Help on https://www.healthcare.gov (CMS-10962)	CMS-10962, CMS_10962	CMS-10962.ENGLISH FLH Page Form Survey ,   CMS-10962. SPANISH_FLH Page Form Survey
[Medicaid] CMS-10909 (Revision): Medicaid.gov Pop-up Survey	CMS-10909	Medicaid.gov Pop-up Survey
[Medicaid] CMS-10910 (Revision): Insure Kids Now Pop-up Survey	CMS-10910	Insure Kids Now Pop-up Survey
[Medicaid] CMS-10911 (Revision): Medicaid.gov Static Feedback	CMS-10911	Medicaid.gov Static Feedback Tool
[Medicaid] Insure Kids Now Customer Feedback Survey (CMS-10910)	CMS-10910	Insure Kids Now Customer Feedback Survey
[Medicaid] Medicaid.gov Customer Feedback Survey (CMS-10909)	CMS-10909	Medicaid.gov Customer Feedback Survey
[Medicaid] Medicaid.gov Feedback Survey (CMS-10911)	CMS-10911, CMS-10911	Medicaid.gov Feedback Survey ,   Medicaid.gov Always On Feedback Survey

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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	1,001,750	1,001,750	0	0	0	0
Annual Time Burden (Hours)	154,433	133,933	0	20,500	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a technical correction to the last approved non-substantive change request.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 02/29/2024

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