PCAP Survey Template APA

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0960-0788)

TITLE OF INFORMATION COLLECTION: Customer Satisfaction Survey for Registration, the Personalized Portal, and the Online Social Security Statement (members of the American Payroll Association)

PURPOSE:

The Social Security Administration (SSA) will be deploying an online process where members of the public are able to register, view their personal information, and both view and print their Social Security statement (Statement) online. (OMB-approved information collection request, OMB Number 0960-0789, SSA’s Public Credentialing and Authentication Process {PCAP}.)

We will be asking for volunteers from the American Payroll Association (APA) to complete the PCAP online registration process, review their personal information, and access their Statement.

We will collect information from the participants to document the user experience with the PCAP functionality including accuracy of the information displayed, ease of use, and measuring overall customer satisfaction. We will use this information to evaluate and improve the PCAP user experience.

We will disseminate the questionnaire to participants through electronic mail (email). The email contains the instructions for completing the survey, a link to the privacy and disclosure information on the Social Security website, the Paperwork Reduction Act statement and OMB approval number, and a link to Survey Monkey where the participants can access the survey questionnaire.

We plan to use Survey Monkey as the collection tool for the survey. Survey Monkey enables us to create our own web-survey in a format participants can easily read and complete.

DESCRIPTION OF RESPONDENTS:

We are soliciting 15 to 30 individuals who do not work for Social Security but have an ongoing relationship with us. We plan to seek volunteers from the APA. The APA is a group of payroll specialists from various large and medium sized businesses with whom we have previously worked (e.g., Governmental Affairs Task Force Subcommittee).

TYPE OF COLLECTION: (Check one)

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

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

[] Focus Group [ ] Other: ______________________

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:______Faye Lipsky, SSA Reports Clearance Officer_____________________

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

BURDEN HOURS:

Category of Respondent	No. of Respondents	Participation Time	Burden
Individuals	30	5 minutes	2 ½ hrs
Totals	30	5 minutes	2 ½ hrs

FEDERAL COST:

There is no 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

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

2. 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?

We plan to solicit a subgroup of the APA for volunteers.

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

2. Will interviewers or facilitators be used? [ ] Yes [x ] No