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

Forms and Documents

Document Name	Status
Form 1 AmeriCorps State and National Symposium Evaluation Form and Instruction	New
Form 1 Pre- and Post-test for Knowledge Management System Form and Instruction	New
Form 1 Senior Corps Focus Groups Form and Instruction	New
Form 1 VISTA PSO Feedback Form and Instruction	New
Form 1 Feedback on 2015 Research Summit Form	New
Form 1 Feedback on Operation AmeriCorps Processes Form and Instruction	New
Form 1 Social Innovation Fund Customer Service Survey Form and Instruction	New
Generic Clearance Submission Template.docx Supplementary Document	2011-04-20
Generic for Feedback Clearance Template Part B 2.10.15.doc Supporting Statement B	2015-03-09
Generic for Feedback Clearance Template Part A 2.10.15.docx Supporting Statement A	2015-03-09

IC Document Collections

IC ID	Document Title	Status
227445	AmeriCorps State and National Symposium Evaluation Form and Instruction	New
226908	Pre- and Post-test for Knowledge Management System Form and Instruction	New
224548	Senior Corps Focus Groups Form and Instruction	New
219470	VISTA PSO Feedback Form and Instruction	New
219367	Feedback on 2015 Research Summit Form	New
217879	Feedback on Operation AmeriCorps Processes Form and Instruction	New
216602	Social Innovation Fund Customer Service Survey Form and Instruction	New

ICR Details

OMB Control No: 3045-0137	ICR Reference No: 201503-3045-001
Status: Historical Active	Previous ICR Reference No: 201406-3045-005
Agency/Subagency: CNCS	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/06/2015
	Date Received in OIRA: 03/09/2015
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.¿

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	36 Months From Approved	08/31/2017
Responses	10,000	0	2,000
Time Burden (Hours)	1,667	0	500
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable CNCS to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the Agency's programs.

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Authorizing Statute(s): US Code: 44 USC 3501 et.seq. Name of Law: Paperwork Reduction Act
  

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:
	79 FR 74096	12/15/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 12157	03/06/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

IC Title	Form No.	Form Name
Senior Corps Focus Groups	1	Senior Corps Focus Group Questions and Survey
Feedback on Operation AmeriCorps Processes	1	Operation AmeriCorps Feedback Interview
Pre- and Post-test for Knowledge Management System	1	Core Curriculum Pre and Post Tests
VISTA PSO Feedback	1	VISTA PSO Feedback Survey
AmeriCorps State and National Symposium Evaluation	1	AmeriCorps State and National Symposium Evaluation Instrument
Feedback on 2015 Research Summit	1	Feedback Form 2015 Research Summit
Social Innovation Fund Customer Service Survey	1	SIF Customer Service Survey Instrument

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ICR Summary of Burden

	Total Approved	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	10,000	2,000	0	8,000	0	0
Annual Time Burden (Hours)	1,667	500	0	1,167	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: The burden has increased due to demand to use this collection.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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? Uncollected

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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: 03/09/2015

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