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

Forms and Documents

Document Name	Status
Form 0920-1071 2018 Customer Satisfaction Survey for CDC NCEH NSMBB Laboratory Accredited to ISO 17043 (Proficiency Testing) Form and Instruction	New
Form 0923-0047 Sub-County Geocoding Standards Survey Form and Instruction	New
Post-Meeting Survey of Attendees of 2018 Environmental PH Tracking Grantee Workshop Form	New
Form 0923-0047 Customer Satisfaction Survey: Vessel Sanitation Program (VSP) Training Seminar Form and Instruction	New
Form 0923-0047 Choose Safe Places for Early Care and Education Survey Form and Instruction	New
Form 0923-0047 NCEH/ATSDR Wellness Needs Assessment Form and Instruction	New
Form 0923-0047 NCEH/ATSDR Wellness Needs Assessment Form and Instruction	New
Post Meeting Survey of State, Local, and Tribal Government Attendees at the NACP Grantee Meeting 2018 Form and Instruction	New
Post Meeting Survey of Non-Governmental Organization (NGO) Attendees at the NACP Grantee Meeting 2018 Form and Instruction	New
Form 0923-0047 CDC GIS Website Content Strategy Survey Form and Instruction	New
Customer Satisfaction Survey for CDC Tobacco Products Laboratory Accredited to ISO/IEC 17025:2005 Form and Instruction	New
Customer Satisfaction Survey for CDC NSMBB Laboratory Accredited to ISO 17043 (Proficiency Testing) Form and Instruction	New
CDC GIS Day Stakeholder Registration and Feedback Form	New
Form 0923-17AZF CDC/ATSDR Needs Assessment of GIS use in Public Health Emergencies Form and Instruction	New
Customer Feedback on ATSDR's Coping with Stress Fact Sheet Form and Instruction	New
National ALS Registry Website Satisfaction Survey Form	New
Form 17AIX Post-Meeti Survey of attendees at the APPLETREE Meeting 2017 Form and Instruction	New
CDC's Social Vulnerability Index Webpage Survey Form and Instruction	New
NCEH/ATSDR Office of Science Regulatory Team Customer Satisfaction Survey Form and Instruction	New
Form 17wl Usability Testing for the National Form and Instruction	New
Council of State and Territorial Epidemiologists (CSTE) Feedback on Geospatial Capacity Form	New
Transportation and Health Tool Website User Satisfaction Assessment Form	New
National Environmental Public Health Internship Program Survey Form and Instruction	New
ToxFAQs Before and After Testing Form and Instruction	New
0923-0047 Revision ATSDR Service Delivery SSB.docx Supporting Statement B	2015-10-15
0923-0047 Revision ATSDR Service Delivery SSA.docx Supporting Statement A	2015-10-15
CDC-specific Service Delivery 60-Day FRN 20140430.PDF Supplementary Document	2015-10-06
ATSDR Draft Generic Clearance for Qualitative Feedback Template Approval Form.docx Supplementary Document	2013-05-02

IC Document Collections

IC ID	Document Title	Status
233473	2018 Customer Satisfaction Survey for CDC NCEH NSMBB Laboratory Accredited to ISO 17043 (Proficiency Testing) Form and Instruction	New
232405	Sub-County Geocoding Standards Survey Form and Instruction	New
231810	Post-Meeting Survey of Attendees of 2018 Environmental PH Tracking Grantee Workshop Form	New
231690	Customer Satisfaction Survey: Vessel Sanitation Program (VSP) Training Seminar Form and Instruction	New
231640	Choose Safe Places for Early Care and Education Survey Form and Instruction	New
231638	NCEH/ATSDR Wellness Needs Assessment Form and Instruction	New
231065	NCEH/ATSDR Wellness Needs Assessment Form and Instruction	New
230078	Post Meeting Survey of State, Local, and Tribal Government Attendees at the NACP Grantee Meeting 2018 Form and Instruction	New
229979	Post Meeting Survey of Non-Governmental Organization (NGO) Attendees at the NACP Grantee Meeting 2018 Form and Instruction	New
229602	CDC GIS Website Content Strategy Survey Form and Instruction	New
228469	Customer Satisfaction Survey for CDC Tobacco Products Laboratory Accredited to ISO/IEC 17025:2005 Form and Instruction	New
228383	Customer Satisfaction Survey for CDC NSMBB Laboratory Accredited to ISO 17043 (Proficiency Testing) Form and Instruction	New
228069	CDC GIS Day Stakeholder Registration and Feedback Form	New
227992	CDC/ATSDR Needs Assessment of GIS use in Public Health Emergencies Form and Instruction	New
227850	Customer Feedback on ATSDR's Coping with Stress Fact Sheet Form and Instruction	New
227786	National ALS Registry Website Satisfaction Survey Form	New
227700	PFAS Exposure Assessment Technical Tools Feedback Instruction	New
226993	Customer Satisfaction Survey: EATS/Food Defense training Other-WORD	New
226803	Post-Meeti Survey of attendees at the APPLETREE Meeting 2017 Form and Instruction	New
226606	CDC's Social Vulnerability Index Webpage Survey Form and Instruction	New
226085	NCEH/ATSDR Office of Science Regulatory Team Customer Satisfaction Survey Form and Instruction	New
225851	Usability Testing for the National Form and Instruction	New
224955	Council of State and Territorial Epidemiologists (CSTE) Feedback on Geospatial Capacity Form	New
222775	Transportation and Health Tool Website User Satisfaction Assessment Form	New
222751	National Environmental Public Health Internship Program Survey Form and Instruction	New
219333	ToxFAQs Before and After Testing Form and Instruction	New

ICR Details

OMB Control No: 0923-0047	ICR Reference No: 201510-0923-001
Status: Historical Active	Previous ICR Reference No: 201305-0923-003
Agency/Subagency: HHS/TSDR	Agency Tracking No: 19457
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: 12/15/2015
	Date Received in OIRA: 10/22/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2018	36 Months From Approved	05/31/2016
Responses	24,900	0	8,400
Time Burden (Hours)	21,225	0	7,275
Cost Burden (Dollars)	0	0	0

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Abstract: The collection of information is necessary to enable the Agency 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): EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  

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 24432	04/30/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 61423	10/13/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 26

IC Title	Form No.	Form Name
NCEH/ATSDR Office of Science Regulatory Team Customer Satisfaction Survey	NA	NCEH/ATSDR Office of Science Regulatory Team Customer Ssatisfaction Survey
PFAS Exposure Assessment Technical Tools Feedback
National ALS Registry Website Satisfaction Survey	none, none	ALS Customer Satisfaction Survey ,   ALS Customer Satisfaction Survey - word
CDC GIS Day Stakeholder Registration and Feedback	none, none	Registration and Feedback ,   Where in the World quiz
Customer Feedback on ATSDR's Coping with Stress Fact Sheet	n/a	Feedback Form and Follow-up Interview Questions
NCEH/ATSDR Wellness Needs Assessment	0923-0047	NCEH/ATSDR Wellness Needs Assessment - Federal Employees/Contractors/Fellows
Customer Satisfaction Survey for CDC NSMBB Laboratory Accredited to ISO 17043 (Proficiency Testing)	n/a	Customer Satisfaction Survey for the CDC Newborn Screening Quality Assurance Program
Transportation and Health Tool Website User Satisfaction Assessment	none, none	User Satisfaction Survey ,   User Satisfaction Survey - screenshots
Customer Satisfaction Survey: EATS/Food Defense training
Customer Satisfaction Survey for CDC Tobacco Products Laboratory Accredited to ISO/IEC 17025:2005	NA	Tobacco Laboratory - Customer Service Survey
CDC/ATSDR Needs Assessment of GIS use in Public Health Emergencies	0923-17AZF, 0923-17AZF	Attachment B GPHEW NA Survey Text ,   Attachment C GPHEW NA Survey Screenshots
ToxFAQs Before and After Testing	NA	Tox FAQs Before and After Testing Survey - Online
Post Meeting Survey of State, Local, and Tribal Government Attendees at the NACP Grantee Meeting 2018	n/a	National Asthma Control Program Grantees Meeting Evaluation
NCEH/ATSDR Wellness Needs Assessment	0923-0047	NCEH/ATSDR Wellness Needs Assessment - Screenshot
Council of State and Territorial Epidemiologists (CSTE) Feedback on Geospatial Capacity	N/A	CSTE Feedback - Use of Geospatial Methods During Responses
Post-Meeti Survey of attendees at the APPLETREE Meeting 2017	17AIX, 17AIX	Attachment B - APPLETREE Post Meeting Survey_screenshot ,   Attachment C - APPLETREE Post Meeting Survey_text
2018 Customer Satisfaction Survey for CDC NCEH NSMBB Laboratory Accredited to ISO 17043 (Proficiency Testing)	0920-1071	CDC Laboratory Customer Satisfaction Survey - CDC NCEH NSMBB Laboratory Proficiency Testing
Usability Testing for the National	17wl	Attachment A - Respondent Screeners
CDC GIS Website Content Strategy Survey	0923-0047	CDC GIS Website Content Strategy Survey
Post Meeting Survey of Non-Governmental Organization (NGO) Attendees at the NACP Grantee Meeting 2018	n/a	National Asthma Control Program Grantees Meeting Evaluation
Choose Safe Places for Early Care and Education Survey	0923-0047	ATSDR Choose Safe Places for Early Care and Education Survey
Sub-County Geocoding Standards Survey	0923-0047	Sub-County Geocoding Standards Survey
National Environmental Public Health Internship Program Survey	NA	National Environmental Public Health Internship Program Survey
Customer Satisfaction Survey: Vessel Sanitation Program (VSP) Training Seminar	0923-0047	VSP Training Seminar Customer Satisfaction Survery Att. A
Post-Meeting Survey of Attendees of 2018 Environmental PH Tracking Grantee Workshop	none	Post-workshop survey - screenshots
CDC's Social Vulnerability Index Webpage Survey	NA	Survey for CDC's Social Vulnerability Index (SVI) Website - Screenshot

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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	24,900	8,400	0	0	16,500	0
Annual Time Burden (Hours)	21,225	7,275	0	0	13,950	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: The increase in burden and respondents is based on the Agency's anticipated number of upcoming GenICs during the next 3 years.

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Annual Cost to Federal Government: $500,000

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: 10/22/2015

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