Supporting Statement

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: Web Survey for Soliciting Feedback for Division of Energy Employees Occupational Illness Compensation (DEEOIC) Energy Document Portal

PURPOSE OF COLLECTION:

This is a revision to an existing electronic survey designed to gather feedback from claimants under the Energy Employees Occupational Illness Compensation Program Act utilizing the Energy Document Portal (EDP) website. This update will include customers using additional functionality within EDP, soliciting feedback on how well the tool works, what type of information they use it to submit, if there are any areas for improvement, and an overall idea of how usable the tool is for our stakeholders. We will use the information to improve our claimants’ experiences and identify potential areas for improvement and/or training within EDP.

TYPE OF ACTIVITY:

[ ] Customer Research (Interview, Focus Groups, Surveys)

[ X ] Customer Feedback Survey

[ ] Usability Testing of Products or Services

ACTIVITY DETAILS

1. If this is a survey, will the results of this survey be reported to Touchpoints as part of quarterly reporting obligations specified in OMB Circular A-11 Section 280?

[ X ] Yes

[ ] No

[ ] Not a survey

2. How will you collect the information?

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

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

3. Who will you collect the information from?

DEEOIC stakeholders who utilize the Energy Document Portal (EDP). Generally this includes claimants and Authorized Representatives.

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

The web survey will be offered to stakeholders after they have visited the Energy Document Portal to file a new claim, upload documents to existing case files, or complete benefit payment forms.

5. What will the activity look like?

The survey identifies that it is an optional collection and includes a sentence detailing the purpose of the collection and burden statement information. The survey includes 11 possible questions, including one comment box. Seven of the questions include a 1-5 Likert scale response, two questions are multiple choice, one is a yes/no, and one open-ended general comment box. 

6. Please provide your question list.

Survey is attached.

7. When will the activity happen?

DEEOIC will work to update the ongoing survey within EDP at the beginning of Q3 FY24. This survey will be ongoing.  

8. Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants?

[ ] Yes [ X ] No

If Yes, describe:

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden Hours
Outreach Event participants (claimants, family members, and Authorized Representatives)	5000	3	250
Totals			250

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;

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. The agency will follow the procedures specified in OMB Circular A-11 Section 280 for the required quarterly reporting to OMB of trust data and experience driver data from surveys.

8. Outside of the quarterly reporting mentioned in the bullet immediately above, if the agency intends to release journey maps, user personas, reports, or other data-related summaries stemming from this collection, the agency must include appropriate caveats around those summaries, noting that conclusions should not be generalized beyond the sample, considering the sample size and response rates. The agency must submit the data summary itself (e.g., the report) and the caveat language mentioned above to OMB before it releases them outside the agency. OMB will engage in a passback process with the agency.

Name and email address of person who developed this survey/focus group/interview:

Name: Allison Spencer

Email address: [email protected]

All instruments used to collect information must include:

OMB Control No. 1225-0093

Expiration Date: 01/31/2027

4