Certification - Generic Clearance Contact Us Tool

Requestfor Approval under the "GenericClearancefor the Collectionof
(OMB ControlNumber:2132-05,4)
RoutineCustomerFeedbaclC'
TION COLLECTION:

for theCollection
Clearance

on AgencyServiceDelivery
Feedback
Qualitative
PURPOSEI FIA's public websiteis the faceof the agencyandone of the mostimportant
communicationtools. The surveywill be conductedto capturecustomersatisfactionwith FTA's
responseandtimelinessto visitors' questionssubmittedvia the ContactUs Tool application.
customerneeds,
thi informationcollectedfrom the surveywill assistFTA in assessing
determininghow well the agencyis respondingto thoseneeds,and taking stepsto improve
service,if needed.

DESCRIPTION OF RESP'ONDENTS: FfA's ContactUs Tool CustomerSatisfactionSurvey
will be usedto
wilt be completedby individualswho useFTA's pubtic website. Their responses
measurecustomersendceand satisfaction.

TYPE O['COLLECTION:

(Checkone)

Form
[ ] CustomerCommentCard/Complaint
(e.g.,
Websirc
or
Software
UsabilityTesting
[]
[] FocusGroup

[X] CustomerSatisfactionSurvey
Group
[ ] SmallDiscussion
[ ] Other:

CERTIFICATION:
I certify the following to be true:
l. The collectionis voluntary.
2. Thecollection is low-burdenfor respondentsand low-cost for the FederalGovemment.
3. The collection is non-controversialand doesE! raise issuesof concernto other federal
agencies.
4. The resultsare not intendedto be disseminatedto the public'
5. Information gatheredwill not be usedfor the purposeof substantiallyinforming influential
policy decisions.
6. The collection is targetedto the solicitation of opinions from respondentswho have
g-;rlay have experiencewith the program in the future.
Name:
To assistr€view,pleaseprovideanswersto the following question:
Personally ldentifiable Information:
l. Is personally identifiable information (PIp collected? [ ] Yes [X ] No
2. If Yes, is the infomration ttrat will be collectedincluded in recordsthat are subjectto the
Privacy Act of 1974? [ ] Yes [ ] No
3. If Applicable,hasa SystemorRecordsNoticebeenpublished?[ ] Yes [ ] No

Gifts or Payments:
providedto
tokenof appreciation)
of expenses,
Is anincentive(e.g.,moneyor reimbursement
participants?
[ ] YesI X] No
BURDENHOI]R.S

Private Sector

Participation
No. of
Resnondents Time
.08
300

Totals

300

Categoryof ResPondent

.08

Burden

24
24

FEDERAL COST: The estimatedannualcost to the Federalgovenrmentis $500.@.
If you are condugtinFa focus eroup. sunev. or,nlan to.gElnlovstatistical methoCg.rrlea$S
orovide answers to the followinq ouestions:
The selection of your targeted respondents
1. Do you have a customerlist or somethingsimilar that definesthe universeof potential
respondentsand do you have a samplingplan for selectingfrom this universe?
[]YeslXlNo
lf the answeris yes,pleaseprovide a descriptionof both below (or attachthe samplingplan)? {
the answeris no, pleaseprwide a descriptionof how you plan to identify your polential gfoup of
respondentsand how you will selectthem?

Administrationof the Instrument
1. How will youcollecttheinformation?(Checkall thatapply)
or otherformsof SocialMedia
[X ] Web-'based
[ ] Telephone
[ ] In-person
[ ] Mail
[ ] Other,Explain
2. Will interviewersor facilitatorsbeused?[ ] YesI X ] No
Pleasemakesure that all instrumentsrlnstnrctions,and scriptsarc submlttedwith the
requesL