Survey Template

Request for Approval under the “Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery” (OMB Control Number: 1905-0210)

2018 EIA Web Customer Survey

PURPOSE: The purpose of this survey is to collect feedback from users of the EIA website to help improve its navigation, web content and presentation, and electronic delivery of energy information. EIA conducts this survey on an annual basis to satisfy its reporting requirements to the U.S. Department of Energy on performance measures about EIA’s website. The results are analyzed internally at EIA to provide the highest quality of energy information to the public.

DESCRIPTION OF RESPONDENTS:

Respondents will be users of U.S. Energy Information Administration’s website.

Website and URL Address

U.S. Energy Information Administration - https://www.eia.gov/

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [X] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software) [ ] Small Discussion Group

[ ] Focus Group [ ] Other: ______________________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: Nanda Srinivasan, Director, Office of Survey Development and Statistical Integration

U.S. Energy Information Administration

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [X ] No

2. If Yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [ X ] No These are statistical records as defined under 5 U.S.C. § 552A(a)(6) maintained for statistical research and not used in whole or in part in making any determination about an identifiable individual. Data will be encrypted when the respondent submits their response to the survey using FIPS 140-2 approved encryption software to protect the PII. The PII will be removed from the survey responses and stored in a separate data user frame file and stored in a restricted access folder.

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time (minutes)	Burden Hours
Totals	35,000	5	2,916

ESTIMATE OF RESPONDENT BURDEN HOURS AND COST – The burden to respondents is 2,916 hours and the cost to the respondents is estimated to be ($75.69* 2,916) = $220,712.

FEDERAL COST: There are no additional costs to the federal government anticipated. Expenses (equipment, overhead, printing, and support staff) will be incurred by EIA components as part of their normal operating budgets.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe?

[ ] Yes [ X] No

The medium for administration of this survey will be the website itself. EIA has created an electronic survey form (HTML document with the questions is attached) that will be posted on the EIA website, allowing customers to easily and automatically submit their feedback. We will present the invitation to the survey after the customer has been on the website for brief period of time. The invitation will ask if they want to take the survey at that moment or have it presented to them at a later time (in five minutes).

The code for fielding the survey is similar to that used by the American Customer Satisfaction Index survey, the survey tool broadly used across the government and cleared by OMB. EIA’s code ensures that our survey will not be blocked by pop-up blocker software. We want to make sure that the broadest possible customer population has the opportunity to respond. We also use temporary cookies to ensure that the survey is only presented once per customer. If they respond to the survey or say they do not want to take it, they will not see the invitation again.

The 10-question survey (not including the possible follow-up questions) is expected to fit on three computer screens. This relatively short survey will encourage participation, as has been our experience in the past.

EIA plans to have this survey on the website for up to seven days, or until 35,000 responses are received. The number of returns will be monitored each day. The response rate is expected to be similar to that seen last year, when we only had the survey online for one week.

Because EIA does not have a list or frame of its website customers, EIA cannot designate a scientific sample, although direct input from customers is needed. We do expect responses from a diverse group of customers based on the fact that customers surveyed in the past represented a diverse group and the sheer volume of input from previous surveys.

While the responses to this survey cannot be claimed as being representative of all users, EIA will get an understanding of users’ opinions by obtaining consistent information from a large number of users. During the survey period, EIA can compute a proxy response rate by calculating survey responses/unique web customers per day, although the actual response percentage for most web surveys is expected to be very small.

All participation in this survey is voluntary. No self-identification information will be requested. All results will be presented in aggregate form. Subsequent analysis of the data collected will limit any divulgence of individual customer responses.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[X] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [X] No

Please make sure that all instruments, instructions, and scripts are submitted with the request.

Instructions for completing Request for Approval under the “Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery”

TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the subject of the request. (e.g. Comment card for soliciting feedback on xxxx)

PURPOSE: Provide a brief description of the purpose of this collection and how it will be used. If this is part of a larger study or effort, please include this in your explanation.

DESCRIPTION OF RESPONDENTS: Provide a brief description of the targeted group or groups for this collection of information. These groups must have experience with the program.

TYPE OF COLLECTION: Check one box. If you are requesting approval of other instruments under the generic, you must complete a form for each instrument.

CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.

Personally Identifiable Information: Provide answers to the questions. Note: Agencies should only collect PII to the extent necessary, and they should only retain PII for the period of time that is necessary to achieve a specific objective.

Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.

BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households; (2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be selected per row.

No. of Respondents: Provide an estimate of the Number of respondents.

Participation Time: Provide an estimate of the amount of time required for a respondent to participate (e.g. fill out a survey or participate in a focus group)

Burden: Provide the Annual burden hours: Multiply the Number of responses and the participation time and divide by 60.

FEDERAL COST: Provide an estimate of the annual cost to the Federal government.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents. Please provide a description of how you plan to identify your potential group of respondents and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.

Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.

Submit all instruments, instructions, and scripts are submitted with the request.

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