Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIOSH 2)

ICR 201505-0920-003

OMB: 0920-0953

Federal Form Document

Forms and Documents
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Supplementary Document
2012-11-01
Supporting Statement B
2015-07-09
Supporting Statement A
2015-07-09
IC Document Collections
IC ID
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231646 New
231621 New
230826 New
230585 New
230190 New
229780 New
226088 New
226013 New
225018 New
224575 New
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222175 New
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219531 New
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219316 New
219258 New
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217876 New
217866 New
217864 New
217668 New
ICR Details
0920-0953 201505-0920-003
Historical Active 201211-0920-003
HHS/CDC 0920-0953
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIOSH 2)
Extension without change of a currently approved collection   No
Regular
Approved with change 07/17/2015
Retrieve Notice of Action (NOA) 06/04/2015
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
07/31/2018 36 Months From Approved 12/31/2015
229,800 0 334,500
57,975 0 86,250
0 0 0

This collection of information is necessary to enable the CDC/NIOSH to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The types of collections that this generic clearance covers include, but are not limited to: Customer comment cards/complaint forms, Small discussion groups, Focus Groups of customers, potential customers, delivery partners, or other stakeholders, Cognitive laboratory studies, such as those used to refine questions or assess usability of a website, Qualitative customer satisfaction surveys (e.g., post-transaction surveys; opt-out web surveys) and In-person observation testing (e.g., website or software usability tests).

PL: Pub.L. 91 - 596 20 Name of Law: Occupational Safety and Health Act of 1970
  
None

Not associated with rulemaking

  79 FR 24432 04/30/2014
80 FR 29710 05/22/2015
No

26
IC Title Form No. Form Name
NORA Agriculture, Forestry, and Fishing Sector Council Feedback through Focus Groups
NIOSH Center for Motor Vehicle Safety Needs Assessment and Audience Analysis
SUNY – Stony Brook CCE WTC Health Program Customer Satisfaction Survey 0920-0953 Member Survey - 2018
The World Trade Center (WTC) Health Program Call Center Satisfaction Survey NA, NA, NA, NA WTCHP Call Center Stisfaction Survey - Program Members ,   WTCHP Call Center Stisfaction Survey - Clinical Centers of Excellence ,   WTCHP Call Center Stisfaction Survey - Health Providers ,   WTCHP Call Center Stisfaction Survey - Pharmacists
User Feedback Questionnaire for ERHMS Info Manager
North Shore LIJ Customer Satisfaction Survey 0920-0953 Queens2018update
Total Worker Health Capacity Building Letter
WTCH Routine Customer Feedback 0920-0953 5-WB2811-Evaluation (3)
Assessment of Personal Protective Equipment Information Database Needs and Capabilities 0920-0953 PPE Survey
World Trade Center (WTC) Health Program General Responder Consortium (GRC) Outreach Survey NA, NA World Trade Center Health Program Member Questionnaire - Telephone Survey ,   World Trade Center Health Program Member Questionnaire - Paper Survey
North Shore LIJ Customer Satisfaction Survey none Customer Satisfaction Survey
Improve Worker Notification Efforts: Survey #3 none Survey #3
Improve Worker Notification Efforts: Survey #2 none Survey 2 Screenshots
WTC Health Program for Responders at Rutgers University none Patient Survey
Assessment of Personal Protective Equipment Information Database Needs and Capabilities 0920-0953 PPE (Personal Protective Equipment) Survey
NORA Agriculture Forestry and Fishing Council 0920-17EO NORA AFF SC questionnaire_Appendix 2
NORA Services Sector Council Questionnaire 0920-0953 National Occupational Research Agenda (NORA)
Assessing and Evaluating the Effectiveness of Hazard Recognition and Risk Assessment Interventions
Improve Worker Notification Efforts: Survey #1 none Survey #1
The Nationwide Provider Network Customer Satisfaction Survey none Survey
NORA Oil and Gas Extraction Council Questionnaire NA NORA Oil and Gas Research Agenda Questionnaire
Long Island World Trade Center Health Program Customer Satisfaction Survey NA Patient Satisfaction Survey
Three Occupation-specific Units for the Workplace Violence Course: Focus Group Discussions for the Stand-alone Facilities, Home Health/Social Services, and Emergency Responder units 0920-0953 Focus Group Discussion Guide Attachment A
NORA Agriculture, Forestry, and Fishing Sector Council Feedback through Informant Interviews
Worker Notification Feedback Survey
The World Trade Center (WTC) Health Program Customer Satisfaction Survey N/A World Trade Center Health Program Member Feedback Questionnaire

  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 229,800 334,500 0 -104,700 0 0
Annual Time Burden (Hours) 57,975 86,250 0 -28,275 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
Decrease in Response/Burden Hours is based on the number of collections the program expects to conduct over the requested period for this clearance.

$112,000
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Jeffrey Zirger 404 639-7118 wtj5@cdc.gov

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/04/2015


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