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

ICR 201802-0920-007

OMB: 0920-0953

Federal Form Document

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Supporting Statement A
2018-06-21
Supplementary Document
2018-04-30
Supplementary Document
2018-02-08
Supporting Statement B
2018-02-08
IC Document Collections
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244466 New
243427 New
242833 New
242116 New
241811 New
240895 New
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ICR Details
0920-0953 201802-0920-007
Active 201505-0920-003
HHS/CDC 0920-0953
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Revision of a currently approved collection   No
Regular
Approved without change 08/27/2018
Retrieve Notice of Action (NOA) 06/27/2018
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
08/31/2021 36 Months From Approved 08/31/2018
154,800 0 229,800
39,225 0 57,975
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).

EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
   PL: Pub.L. 91 - 596 20 Name of Law: Occupational Safety and Health Act of 1970
  
None

Not associated with rulemaking

  83 FR 12766 03/23/2018
83 FR 29558 06/25/2018
Yes

32
IC Title Form No. Form Name
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 n/a Focus Group Discussion Guide for Online Workplace Violence Prevention Best Practices Courses
Telehealth Satisfaction at MSSM 0920-0953 Telehealth Satisfaction Survey
Mount Sinai WTC Health Program Clinical Center of Excellence After Visit Questionnaire
Winch Entanglement Prevention Technology Interviews 0920-0953, 0920-0953 Opening Script and Eligibility Screening Form ,   Representative Question Stems for Interviews
Patient Satisfaction Survey Stony Brook 0920-0953 Patient Satisfaction Survey
Barriers to Care Assessment for WTC Health Program Care at Mt. Sinai none, none, none Member Questionnaire - English ,   Member Questionnaire - Polish ,   Member Questionnaire - Spanish
Treatment Satisfaction Survey - NYU none, none Treatment Satisfaction Survey - English ,   Treament Satisfaction Survey - Spanish
Mount Sinai WTC Health Program Clinical Center of Excellence After Visit Questionnaire 0920-0953 Telehealth Services Satisfaction Questionnaire
Barriers to Care Assessment for WTC Health Program Care at MSSM none Barriers to Care Assessment
Occupational Data for Health (ODH) Prototype usability testing 0920-0953, 0920-0953, 0920-0953, 0920-0953, 0920-0953, 0920-0953 Occupational Data for Health (OHD) Phototype Version 3 ,   Employment Status & Retirement dates ,   Longest Held Occupation ,   Work History ,   PRE-TEST DEMOGRAPHIC DATA SURVEY FOR OCCUPATIONAL DATA FOR HEALTH (ODH) PROTOTYPE USABILITY TESTING ,   POST-TEST SURVEY FOR OCCUPATIONAL DATA FOR HEALTH (ODH)
Interviews to solicit feedback on COVID-19 Worker Factsheets 0920-20OY Fact sheet testing interview instrument
Worker Notification Feedback Survey 0920-0953 Worker Notification Feedback Survey
Patient Satisfaction Survey Stony Brook 0920-0953, 0920-0953 Participation in WTC Health Program at NYUSOM Clinical Center of Excellence ,   Participation in WTC Health Program at NYUSOM Clinical Center of Excellence (Spanish Version)
EOHSI/Rutgers Clinical Center of Excellence Annual Monitoring Exam Patient Satisfaction Survey 0920-0953 Rutgers Patient Satisfaction Survey 2019
Mount Sinai World Trade Center Health Program Clinical Center of Excellence Annual Satisfaction Survey 0920-0953 WTC Mt. Sinai Medical Center Annual Survey
2019 NIOSH Centers Grantee Meeting Evaluation Survey none Grantee Meeting Evaluation
Customer Survey for the World Trade Center Health Program Nutrition Department (Stony Brook) n/a World Trade Center Health Program Nutrition Survey
Occupational Exposure Banding Survey
Focus Groups-retain Employers 0920-0953, 0920-0953 Focus Group Discussion Guide For Employers ,   Focus Group Discussion Guide For Employees
TWH Webinar Series 0920-0953 Webinar Questions
Surveillance Systems Feedback Survey none Systems Application Feedback
Course Evaluation for Continuing Education Webinars-WTCHP
NORA CRC Cross-Sector Council Questionnaire 0920-0953 Cross-Sector Survey
Survey to Solicit Feedback on Expanding Research Partnerships: State/Local/Tribal Govt n/a Feedback Survey on the "Expanding Research Partnerships" webinar series
Survey to Solicit Feedback on Expanding Research Partnerships: Individuals n/a Feedback Survey on the "Expanding Research Partnerships" webinar series
NYC Health + Hospitals World Trade Center Environmental Health Center Customer Satisfaction Survey 0920-0953 WTC Environmental Health Center Customer Satisfaction Survey
Survey to Solicit Feedback on TA on Worker Safety and Health provided as part of COVID response none, none Field TA Survey ,   Virtual TA Survey
Member Satisfaction Survey - Stony Brook none Member Satisfaction Survey
Survey to Solicit Feedback on Expanding Research Partnerships: Federal Govt n/a Feedback Survey on the "Expanding Research Partnerships" webinar series
Survey to Solicit Feedback on Expanding Research Partnerships: Private Sector n/a Feedback Survey on the "Expanding Research Partnerships" webinar series
Telehealth Satisfaction at Mt. Sinai School of Medicine (MSSM) n/a Telehealth Services Patient Satisfaction Questionnaire
Telehealth Satisfaction at MSSM 0920-0953 TMH QA 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 154,800 229,800 0 -75,000 0 0
Annual Time Burden (Hours) 39,225 57,975 0 -18,750 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
Burden reduction due to adjusting for unused hours and planned efforts within NIOSH for next three years.

$112,000
Yes Part B of Supporting Statement
    No
    No
No
No
No
Uncollected
Shari Steinberg 404 639-4942 sxw2@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.
06/27/2018


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