Generic Clearance Submission Template ACS (4-2015)

Instructions
U.S. Department

of State

REQUEST FOR APPROVAL UNDER THE "GENERIC CLEARANCE
FOR THE COLLECTION OF ROUTINE CUSTOMER FEEDBACK"
OMB CONTROL NUMBER: 1405-0193
Title of Information Collection

Consular Services: American Citizen Services Applicant Satisfaction Survey

Purpose

The Bureau of Consular Affairs (CA) currently uses OMB approved survey SV -2013-0003 to assess the level of American citizen
customer satisfaction with the consular services provided overseas in U.S. diplomatic and consular missions. That form does not
ask questions that refer to operational matters with the specificity needed to determine adequately customer satisfaction at each of
the more than 200 consular sections overseas. For example, question 3 combines two very different matters, i.e, obtaining
information and obtaining an appointment. Consular sections provide information on the requirements of specific services through
multiple channels, i.e. the Department's website, the post's website, the CAlOCS call center, the post's phone system, and email.
CA would like to ask customers which info source they consulted and whether the info was helpful. Given that many American
citizens who reside overseas are not fluent in English, CA would also like to determine whether customers sought info in another
language. With regard to appointment systems, access to such systems is generally via the internet. In many overseas locations,
American citizens have limited access to the internet.
The proposed form would permit CA to aggregate responses to obtain a general satisfaction rating, but it would also allow an
individual post to modify specific operational matters to suit better the specific makeup of its locally resident American population.

Description

of Respondents

Respondents would generally be American citizens who are applying for a consular service in a U.S. diplomatic or consular
mission overseas. In those instances in which the applicant is a minor, respondents would be the minor's parent or legal guardian.
Such individuals may not be American citizens.
Respondents who are seeking notarial services may also not be American citizens. A foreigner may request a notarial service if the
documents to be notarized are to be used in the United States.
\

Type of Collection:

o
o
o

(Check one)

Customer Comment Card/Complaint

!Xl

Form

o
o

Usability Testing (e.q., Web site or Software)
Focus Group

Customer

Satisfaction

Small Discussion

Survey

Group

Other

Certification
I certify the following to be true:
1.

The collection is voluntary.

2.

The collection is low-burden

3.

The collection is non-controversial

for respondents

and low-cost for the Federal government.

4.

The results are not intended to be disseminated

5.

Information gathered will not be used for the purpose of substantially

6.

The collection is targeted to the solicitation
the program in the future.

and does not raise issues of concern to other Federal agencies.
to the public.
informing influential policy decisions.

of opinions from respondents

who have experience

with the program or may have experience

with

Title

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Signature
08-4183
06-2011

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Page 1 of 2

Instructions
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Personally
1.

REView,

~~EASE

PROVIDE ANSWERS"hiTHE

,.",

Identifiable

,.,'

.

FOLLOWING

Is personally identifiable information

If Applicable,

':NY'

"

"

Information
(PII) collected?

a. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974?
2.

~::"

QUESTIONS.

,'0

has a System of Records Notice been published?

0
0
0

Yes

[Xl

No

Yes

D

No

Yes

D

No

D

Yes

[Xl

No

Gifts or Payments
Is an incentive (e.g., money or reimbursement

I~

"

~t~

of expenses, token of appreciation)

\,;

3$"

jiURDEN

"

Category of Respondent

Number of Respondents

i~\

The estimated

annual cost to the Federal government

::

Participation

~EDERAL

COST

'':,7,

Time (Minutes)

1';'.',

1.

250.00

St;

of your targeted

!WW

i,'

$1,500.00

is

OR

The selection

Burden Hours

3
ro~%

:W

250.00

IF YOU ARE'CONOOCTING
A FOCUS GROUP. SURVEY,
PLAN TO EMPL,OY
$TATISTICALMETHODS,
PROVIPE ANSWERS TO THE FOLLOWING QUESTlQNS

z

,.

"·~t·.

3

5,000

Totals

s;

"",~••• >

5,000

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\4

HOURSil~:.

Individuals or Households

if,

provided to participants?

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respondents

Do you have a customer list or something similar that defines the universe of potential respondents
selecting from this universe? DYes
No

and do you have a sampling plan for

[Xl

If the answer is yes, please provide a description of both below (or attach the sampling pian).
of how you plan to identify your potential group of respondents and how you will select them.

If the answer is no, please provide a description

The survey would be provided to applicants who personally visit a U.S. consular office overseas to seek a service available to
American citizens. There are approximately 85 of our 240 offices that average 250 applicants per year. For this population of
potential respondents, the survey form would be handed out to applicants on paper and data collection would be handled by a
clerical employee.
CA is considering obtaining a license to use Survey Monkey or similar technology to be used by respondents who seek
services at our larger posts that are located in major urban areas. Should that occur, we will provide additional information to
OMB for consideration.

Administration
1.

2.

of the Instrument

How will you collect the information?

[Xl

Web-based

D

Telephone

[Xl

In-person

D

Mail

[Xl

Other, Explain

(Check al/ that apply)

or other forms of Social Media

Computer terminal in the consular waiting room

Will interviewers or facilitators

be used?

DYes

[Xl

PLEASE MAKE SUR': THAT ALL INSTRUMENTS,

05-4183

No
INSTRUCll0NS,

AriO"SCR1US

ARE SUBMlmp

WITH THe, REQUEST.
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