CISOMB Customer Satisfaction and Needs Assessment Survey

Forms and Documents

Document Name	Status
Form DHS-NEW Customer Satisfaction Survey Form and Instruction	New
1601-NEW_Published 30 day FRN.pdf Supplementary Document	2016-02-22
1601-NEW_Published 60 day FRN.pdf Supplementary Document	2015-11-30
PL 107-296.pdf Supplementary Document	2015-11-09
PTA HQ CISOMB - Customer Satisfaction Survey 20150326 PRIV FINAL (3).pdf Supplementary Document	2015-11-09
CISOMB Customer Satisfaction Survey Supporting Statement B 8-10-2015.doc Supporting Statement B	2015-11-09
1601-NEW_CISOMB Customer Service Survey Supporting_Statement_A_May2016.docx Supporting Statement A	2016-05-19

IC Document Collections

IC ID	Document Title	Status
218904	Customer Satisfaction Survey Form and Instruction	New

ICR Details

OMB Control No: 1601-0021	ICR Reference No: 201511-1601-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DHS/OS	Agency Tracking No:
Title: CISOMB Customer Satisfaction and Needs Assessment Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/20/2016
	Date Received in OIRA: 03/02/2016
Terms of Clearance: Given the voluntary nature of this survey, the agency will not use information gained to draw statistical inferences on the target population. This approval is granted with the understanding that the agency intends to use the results of the survey (qualitative statements) received to consider how to improve operations and customer service. The information received will not alone be used to justify reallocation of resources or to change policies.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2019	36 Months From Approved
Responses	8,800	0	0
Time Burden (Hours)	4,400	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The information collected on this form will allow the CIS Ombudsman to obtain feedback from the general public to assess the needs of customers to and identify improvement opportunities for Ombudsman services.

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Authorizing Statute(s): PL: Pub.L. 107 - 296 452 Name of Law: Homeland Security Act of 2002
  

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:
	80 FR 69241	11/09/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 8737	02/22/2016
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Customer Satisfaction Survey	DHS-NEW	Customer Satisfaction Survey

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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	8,800	0	0	8,800	0	0
Annual Time Burden (Hours)	4,400	0	0	4,400	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: This is a new collection.

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Annual Cost to Federal Government: $176,000

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: 03/02/2016

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