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

Forms and Documents

Document Name	Status
Form 6100-078 Water Technical Assistance Request Form & Needs Assessment Form and Instruction	New
Form 6700-034 Feedback survey for participants of Healthy Homes and ECO Neighborhoods' learning experiences Form	New
Form 6200-030 Brownfields Minimizing Displacement Technical Assistance Participant Satisfaction Survey Form	New
Form 6200-033 Groundwork USA Nonprofit Technical Assistance Grant Satisfaction Surveys Form	New
Form 6200-031 Customer Satisfaction Surveys for Feedback on Technical Assistance to Brownfield Communities Form	New
Form 6200-035 Land Revitalization Technical Assistance program (LRTA) Customer Satisfaction Survey Form	New
Form 5800-095 Feedback Survey: NWEJC Launch Event Form	New
Form 6000-023 Crisfield Resilience Academy Form	New
Form 6000-030 Equitable Resilience Builder Tool Feedback Survey Form	New
Form 6700-032 Cuyahoga County Board of Health Feedback Activity during Health Impact Assessment Training Sessions Form and Instruction	New
Form 6700-031 Climate & Sustainability Event Survey for the GPCOG EJG2G Community Resilience Program Form	New
Form 6700-030 Oʻahu Climate Champions Final Reflection Form and Instruction	New
Form 6700-029 Oʻahu Climate Champions Monthly Reflections Form and Instruction	New
Form 6700-027 Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline Survey Form	New
Form 6700-021 Lower Duwamish Waterway Superfund Site ICIAP "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms Form	New
Form 6700-025 LISS Partnership DEI/EJ Readiness Survey Form	New
Form 5800-091 Customer Satisfaction Surveys for feedback on the EJ TCTACs Form	New
Form 6100-081 Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations Form and Instruction	New
Form 9600-071 Pesticide Safety Education Funds Management Program Customer Satisfaction Survey Form	New
Form 5800-089 Environmental and Climate Justice Community Change Technical Assistance Form	New
Form 6700-012 Gulf of Mexico Division Funding Opportunities Form	New
Form 5800-086 Customer Satisfaction Survey for EPA's Adaptation Resource Center (ARC-X) Form and Instruction	New
Form 6700-011 Impact Analysis Questions for Communities in the Southeast New England Program Network (SNEP) Form	New
Form 5800-0085 ECHO Tools Survey Form	New
Form 9600-036 Train-the-Trainer 6-month Post-Survey – Community Lead Awareness (CLA) Form	New
Form 9600-035 Train-the-Trainer Post-Survey – Community Lead Awareness (CLA) Form	New
Form 9600-034 Understanding Lead Post-Survey – Community Lead Awareness (CLA) Form	New
Form 9600-033 Train-the-Trainer Pre-Survey – Community Lead Awareness (CLA) Form	New
Form 9600-032 Understanding Lead Pre-Survey – Community Lead Awareness (CLA) Form	New
Form 6000-019 NAMs Training Surveys Form	New
Form 5800-081 DSIMB – ICIS Customer Support Training Questions Form	New
Form 6700-010 Greening Urban Neighborhoods from the Ground Up Form	New
Form 6100-090 Campus RainWorks Challenge Survey Form	New
Form 5800-059 Planning with Structured Decision Making/DASEES Form	New
Form 5800-049 Great Lakes AOC Project Area Community Use and Benefits Intercept (Customer Satisfaction) Survey Form	New
Form 5800-047 EPA Water Quality Standards Academy Student Course Evaluation Form	New
Form 5800-043 Evaluations for the National Tanks Conference and Expo Form	New
Form 9600-070 EPA Certification Plan and Reporting Database Users Survey Form	New
Form 5800-041 Customer Satisfaction Survey for State Government Officials on ORD Research Area Coordination Teams Form	New
Form 5800-011 Science Matters Newsletter Customer Satisfaction Survey Form	New
Form 5800-010 DSIMB Helpdesk Survey Form	New
Form 5800-003 EPA Docket Center Customer Satisfaction Survey Form	New
Form 5800-038 eGRID User Satisfaction Survey Form	New
Form 5800-037 ECHO Training Questions Form	New
Form 5800-024 Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA Form	New
Form 5800-017 Office of Administrative Law Judges Alternative Dispute Resolution Process User Survey Form	New
2434ssb204.docx Supporting Statement B	2024-06-27
2434ssa204.docx Supporting Statement A	2024-06-27
Qualitative Feedback IC Request Template (2434.204).docx Supplementary Document	2024-06-27

IC Document Collections

IC ID	Document Title	Status
269091	Water Technical Assistance Request Form & Needs Assessment Form and Instruction	New
269039	Focus Groups for Development new EPA Label Program for Low Embodied Carbon Construction Materials & Products Instruction	New
268171	Pipe Up Campaign Phase 3: Campaign Message Testing Other-Intro Page	New
268170	Feedback survey for participants of Healthy Homes and ECO Neighborhoods' learning experiences Form	New
268167	Brownfields Minimizing Displacement Technical Assistance Participant Satisfaction Survey Form	New
268166	Groundwork USA Nonprofit Technical Assistance Grant Satisfaction Surveys Form	New
268164	Customer Satisfaction Surveys for Feedback on Technical Assistance to Brownfield Communities Form	New
268163	Land Revitalization Technical Assistance program (LRTA) Customer Satisfaction Survey Form	New
268162	Feedback Survey: NWEJC Launch Event Form	New
268161	Crisfield Resilience Academy Form	New
268159	Equitable Resilience Builder Tool Feedback Survey Form	New
268129	Cuyahoga County Board of Health Feedback Activity during Health Impact Assessment Training Sessions Form and Instruction	New
268128	Climate & Sustainability Event Survey for the GPCOG EJG2G Community Resilience Program Form	New
268127	Oʻahu Climate Champions Final Reflection Form and Instruction	New
268126	Oʻahu Climate Champions Monthly Reflections Form and Instruction	New
268123	Channelview ISD Teacher discussion to identify project priorities and needs for the 2024-25 school year Instruction	New
268122	Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline Interview Instruction	New
268120	Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline Survey Form	New
268119	Lower Duwamish Waterway Superfund Site ICIAP "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms Form	New
268118	LISS Partnership DEI/EJ Readiness Survey Form	New
268115	Customer Satisfaction Surveys for feedback on the EJ TCTACs Form	New
268112	Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations Form and Instruction	New
268110	Pesticide Safety Education Funds Management Program Customer Satisfaction Survey Form	New
268107	Environmental and Climate Justice Community Change Technical Assistance Form	New
268106	Gulf of Mexico Division Funding Opportunities Form	New
268105	Customer Satisfaction Survey for EPA's Adaptation Resource Center (ARC-X) Form and Instruction	New
268104	Impact Analysis Questions for Communities in the Southeast New England Program Network (SNEP) Form	New
268103	ECHO Tools Survey Form	New
268102	Focus groups for feedback on the EJ TCTACs Other-Focus Group Topic Guide	New
268101	Train-the-Trainer 6-month Post-Survey – Community Lead Awareness (CLA) Form	New
268100	Train-the-Trainer Post-Survey – Community Lead Awareness (CLA) Form	New
268099	Understanding Lead Post-Survey – Community Lead Awareness (CLA) Form	New
268098	Train-the-Trainer Pre-Survey – Community Lead Awareness (CLA) Form	New
268097	Understanding Lead Pre-Survey – Community Lead Awareness (CLA) Form	New
268096	NAMs Training Surveys Form	New
268094	DSIMB – ICIS Customer Support Training Questions Form	New
268093	Greening Urban Neighborhoods from the Ground Up Form	New
268092	Campus RainWorks Challenge Survey Form	New
268091	Planning with Structured Decision Making/DASEES Form	New
268090	Great Lakes AOC Project Area Community Use and Benefits Intercept (Customer Satisfaction) Survey Form	New
268089	EPA Water Quality Standards Academy Student Course Evaluation Form	New
268088	Evaluations for the National Tanks Conference and Expo Form	New
268087	EPA Certification Plan and Reporting Database Users Survey Form	New
268086	Customer Satisfaction Survey for State Government Officials on ORD Research Area Coordination Teams Form	New
268085	Science Matters Newsletter Customer Satisfaction Survey Form	New
268084	DSIMB Helpdesk Survey Form	New
268083	EPA Docket Center Customer Satisfaction Survey Form	New
268082	eGRID User Satisfaction Survey Form	New
268081	ECHO Training Questions Form	New
268080	Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA Form	New
268079	Office of Administrative Law Judges Alternative Dispute Resolution Process User Survey Form	New

ICR Details

OMB Control No: 2030-0051	ICR Reference No: 202404-2030-001
Status: Received in OIRA	Previous ICR Reference No: 202106-2030-001
Agency/Subagency: EPA/OMS	Agency Tracking No: 2434.204
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (Renewal)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/28/2024

	Requested	Previously Approved
Expiration Date	36 Months From Approved	07/31/2024
Responses	180,000	180,000
Time Burden (Hours)	45,000	45,000
Cost Burden (Dollars)	0	0

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Abstract: The information collection activity provides the Agency with an opportunity to efficiently engage its customers and stakeholders by gathering qualitative information about their interaction with Agency. Getting such feedback in a timely manner is critical if the Agency is to know how and where it should focus while seeking to improve, or expand upon, its products and services. The Agency will submit a collection request for approval under this generic clearance only if the collections are: Voluntary; low burden and low-cost for both the respondents and the Federal Government; noncontroversial; targeted to respondents who have experience with the program or may have experience with the program in the near future; and abstain from collecting personally identifiable information (PII) to the greatest extent possible. Information gathered will be used internally for general service improvement and program management purposes and released publicly only in an anonymized or aggregated fashion. It will not be used to substantially inform influential policy decisions.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Setting 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:
	89 FR 5228	01/26/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 46886	05/30/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 51

IC Title	Form No.	Form Name
Brownfields Minimizing Displacement Technical Assistance Participant Satisfaction Survey	6200-030	Minimizing Displacement Resulting from Brownfields Assessment, Cleanup and Reuse
Campus RainWorks Challenge Survey	6100-090	Campus RainWorks Survey
Channelview ISD Teacher discussion to identify project priorities and needs for the 2024-25 school year
Climate & Sustainability Event Survey for the GPCOG EJG2G Community Resilience Program	6700-031	Climate & Sustainability Event Survey
Crisfield Resilience Academy	6000-023, 6000-024, 6000-025, 6000-026	CRISFIELD RESILIENCE ACADEMY: PRE-SURVEY QUESTIONS ,   CRISFIELD RESILIENCE ACADEMY: POST-SURVEY QUESTIONS ,   Crisfield Resilience Academy Session Evaluation ,   Crisfield 6-month Post-Academy Interview Protocol
Customer Satisfaction Survey for EPA's Adaptation Resource Center (ARC-X)	5800-086	ARC-X User Satisfaction Survey
Customer Satisfaction Survey for State Government Officials on ORD Research Area Coordination Teams	5800-041	ORD State Engagement Feedback Survey on RACT Participation
Customer Satisfaction Surveys for Feedback on Technical Assistance to Brownfield Communities	6200-031	Technical Assistance to Brownfield Communities – Evaluation Questions
Customer Satisfaction Surveys for feedback on the EJ TCTACs	5800-091, 5800-092, 5800-093	EJ TCTAC Intake Form Center A ,   EJ TCTAC Intake Form Center B ,   EJ TCTAC Intake Form Center C
Cuyahoga County Board of Health Feedback Activity during Health Impact Assessment Training Sessions	6700-032	HIA Training Feedback Storytelling Activity
DSIMB Helpdesk Survey	5800-010	DSIMB Helpdesk Survey Questions
DSIMB – ICIS Customer Support Training Questions	5800-081	DSIMB Post Training Survey Questions
ECHO Tools Survey	5800-0085	ECHO Tool Survey Questions
ECHO Training Questions	5800-037	ECHO Post Training Survey Questions
EPA Certification Plan and Reporting Database Users Survey	9600-070	Survey of Certification Plan and Reporting Database Users
EPA Docket Center Customer Satisfaction Survey	5800-003	EPA Docket Center Customer Service Survey
EPA Water Quality Standards Academy Student Course Evaluation	5800-047	Water Quality Standards Academy Evaluation Form
Environmental and Climate Justice Community Change Technical Assistance	5800-089	Environmental and Climate Justice Community Change Technical Assistance Request Form
Equitable Resilience Builder Tool Feedback Survey	6000-030	Equitable Resilience Builder Tool Feedback Survey
Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA	5800-034, 5800-024, 5800-027, 5800-035, 5800-036	ECCR Agreement Seeking Participant Evaluation Survey ,   ECCR Facilitated Dialogue Participant Questionnaire ,   ECCR Long Term Group Facilitation Participant Questionnaire ,   ECCR Meeting Facilitation Questionnaire ,   ECCR Training Participant Evaluation Survey
Evaluations for the National Tanks Conference and Expo	5800-043, 5800-044	Individual Session Evaluation Form: National Tanks Conference ,   Conference Evaluation Form: National Tanks Conference and Expo
Feedback Survey: NWEJC Launch Event	5800-095	Feedback Survey: Northwest Environmental Justice Center Launch Event
Feedback survey for participants of Healthy Homes and ECO Neighborhoods' learning experiences	6700-034, 6700-035	Healthy Homes and ECO Neighborhoods Survey ,   Healthy Homes Assessment and Energy Audit Feedback
Focus Groups for Development new EPA Label Program for Low Embodied Carbon Construction Materials & Products
Focus groups for feedback on the EJ TCTACs
Great Lakes AOC Project Area Community Use and Benefits Intercept (Customer Satisfaction) Survey	5800-049	Great Lakes AOC User Satisfaction Survey
Greening Urban Neighborhoods from the Ground Up	6700-010	Far Eastside Survey
Groundwork USA Nonprofit Technical Assistance Grant Satisfaction Surveys	6200-033	Groundwork USA Nonprofit Technical Assistance Grant Customer Satisfaction Survey
Gulf of Mexico Division Funding Opportunities	6700-012	GMD Funding Opportunities
Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline Interview
Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline Survey	6700-027, 6700-028	Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline 1st Survey ,   Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline 2nd Survey
Impact Analysis Questions for Communities in the Southeast New England Program Network (SNEP)	6700-011	Impact Analysis Questions for Communities
LISS Partnership DEI/EJ Readiness Survey	6700-025	LISS Partnership DEI/EJ Survey
Land Revitalization Technical Assistance program (LRTA) Customer Satisfaction Survey	6200-035	Land Revitalization Technical Assistance to Brownfields Communities (LRTA) – Evaluation Questions
Lower Duwamish Waterway Superfund Site ICIAP "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms	6700-021, 6700-022, 6700-023, 6700-018, 6700-019, 6700-026, 6700-020, 6700-017, 6700-016, 6700-015, 6700-014, 6700-013	CHA Behavior Survey ,   Pre-Assessment of CHAs-in-Training ,   Post-Assessment of CHAs-in-Training ,   Fishers Workshop Background Survey ,   Fishers Workshop PRE-Survey ,   Fishers Workshop POST-Survey ,   Fishers Workshop Pledges ,   Moms and Caregivers Background Survey ,   Moms and Caregivers Mini Quiz ,   Moms and Caregivers Pledges ,   Moms and Caregivers Self-Assessment ,   Outreach Event Survey
NAMs Training Surveys	6000-019, 6000-020	NAMs Pre-Training Registration ,   NAMs Post-Training Feedback
Office of Administrative Law Judges Alternative Dispute Resolution Process User Survey	5800-017	ADR User Survey
Oʻahu Climate Champions Final Reflection	6700-030	Climate Champions Final Reflection
Oʻahu Climate Champions Monthly Reflections	6700-029	Climate Champion Monthly Reflection
Pesticide Safety Education Funds Management Program Customer Satisfaction Survey	9600-071	Customer Satisfaction Survey: PSEFMP Application Process
Pipe Up Campaign Phase 3: Campaign Message Testing
Planning with Structured Decision Making/DASEES	5800-059	Planning with Structured Decision Making/DASEES
Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations	6100-081, 6100-082	Screener - Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations ,   Discussion Guide - Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations
Science Matters Newsletter Customer Satisfaction Survey	5800-011	Science Matters Survey
Train-the-Trainer 6-month Post-Survey – Community Lead Awareness (CLA)	9600-036	Lead Awareness Curriculum Session Train-the-Trainer Follow-up Survey
Train-the-Trainer Post-Survey – Community Lead Awareness (CLA)	9600-035	Train-the-Trainer Post-Survey
Train-the-Trainer Pre-Survey – Community Lead Awareness (CLA)	9600-033	Train-the-Trainer Pre-Survey
Understanding Lead Post-Survey – Community Lead Awareness (CLA)	9600-034	Understanding Lead Post-Survey
Understanding Lead Pre-Survey – Community Lead Awareness (CLA)	9600-032	Understanding Lead Pre-Survey
Water Technical Assistance Request Form & Needs Assessment	6100-078	Water TA Request Form & Needs Assessment
eGRID User Satisfaction Survey	5800-038	eGRID User Satisfaction Survey

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ICR Summary of Burden

	Total Request	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	180,000	180,000	0	0	0	0
Annual Time Burden (Hours)	45,000	45,000	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $18,000

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: 06/28/2024

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