Generic Clearance Submission for Free Cybersecurity Services and Tools Intake Form

Generic Clearance Submission for Free Cybersecurity Services and Tools Intake Form_20230728.docx

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Generic Clearance Submission for Free Cybersecurity Services and Tools Intake Form

OMB: 1670-0027

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Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 1670-0027)


Shape1 TITLE OF INFORMATION COLLECTION: Free Cybersecurity Services and Tools Intake Form


PURPOSE: The purpose of this intake form is to facilitate and improve the process that CISA created for organizations to voluntarily submit free cybersecurity tools and services. The voluntary submissions would be reviewed for consideration to be included on the Free Cybersecurity Services and Tools web page.


DESCRIPTION OF RESPONDENTS: Private organizations and companies, State, Local, Tribal, and Territorial governments (SLTT)


TYPE OF COLLECTION: (Check one)


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

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

[ ] Focus Group [ X] Other: Intake form____


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: Jacqueline Cross_


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

  3. If Applicable, has a System or Records Notice been published? [ ] Yes [X ] No

Gifts or Payments:

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

s




BURDEN HOURS

Type of

Respondent

Form Name/Form Number

No. of

Respondents

No. of

Responses

per

Respondent

Avg.

Burden per

Response

(in hours)**

Total

Annual

Burden

(in hours)

Avg.

Hourly

Wage

Rate*

Total

Annual

Respondent

Cost

Private companies, SLTT

CISA Free Services and Tools intake form

20

1

.083

1.67

$42.20

$70.3

Totals


20



1.67


70.3

NOTES ON HOUR BURDEN:
*  The above Average Hourly Wage Rate is the May 2022 Bureau of Labor Statistics average wage for “All Occupations” of $29.76 times the wage rate benefit multiplier of 1.41805 (to account for fringe benefits) equaling $42.20. The benefits multiplier is calculated by dividing total compensation by salaries and wages based on the BLS Employer Cost for Employee Compensation 2022 Q4 results (table 4 – Employer Cost for Employer Compensation for private Industry Workers by Occupational and Industry Group). The selection of “All Occupations” (for example) was chosen as the expected respondents for this collection could be expected to be from any occupation.

FEDERAL COST:


The estimated annual cost to the Federal government is $__13,678.20_.

The following method was used to estimate the cost (based on General Schedule Grade _14_, step 2__, WASHINGTON-BALTIMORE-NORTHERN VIRGINIA, DC-MD-VA-WV-PA locality, fully loaded annual pay of $__$136,780 _ with an hourly wage of $_65.54_: 1 personnel x 10% annual time (_2087__ hours) = $__13,678.20_.



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?


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

  1. Will interviewers or facilitators be used? [ ] Yes [ X ] No

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

Instructions for completing Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”


Shape2

TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the subject of the request. (e.g. Comment card for soliciting feedback on xxxx)


PURPOSE: Provide a brief description of the purpose of this collection and how it will be used. If this is part of a larger study or effort, please include this in your explanation.


DESCRIPTION OF RESPONDENTS: Provide a brief description of the targeted group or groups for this collection of information. These groups must have experience with the program.


TYPE OF COLLECTION: Check one box. If you are requesting approval of other instruments under the generic, you must complete a form for each instrument.


CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.


Personally Identifiable Information: Provide answers to the questions.


Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.


BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households;(2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be selected.

No. of Respondents: Provide an estimate of the Number of respondents.

Participation Time: Provide an estimate of the amount of time required for a respondent to participate (e.g. fill out a survey or participate in a focus group)

Burden: Provide the Annual burden hours: Multiply the Number of responses and the participation time and divide by 60.


FEDERAL COST: Provide an estimate of the annual cost to the Federal government.


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. Please provide a description of how you plan to identify your potential group of respondents and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.


Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.


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


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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleDOCUMENTATION FOR THE GENERIC CLEARANCE
Author558022
File Modified0000-00-00
File Created2024-07-21

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