Certification

Request for Approval under the “Generic Clearance for the Collection of
Routine Customer Feedback” (OMB Control Number: 0579-0377)
TITLE OF INFORMATION COLLECTION: Highly Pathogenic Avian Influenza (HPAI)
Emergency Response Responder Feedback Survey
PURPOSE: This Responder Feedback Survey seeks to collect observations from HPAI emergency
response personnel regarding their HPAI emergency response roles, assignments, and experiences.
This online survey provides a venue to receive feedback to evaluate current response activities and
make recommendations and changes to improve the Animal and Plant health Inspection Service’s
HPAI emergency response capabilities and efforts in a timely, effective, and efficient manner. This
survey has also been conducted on APHIS personnel (exempt from the Paperwork Reduction Act)
who responded along with the responders (State and contracted/business) this information collection
is seeking approval to survey.
DESCRIPTION OF RESPONDENTS: Respondents include persons who work in or have
expertise, knowledge, and skills in the fields of animal health, epidemiology, and welfare; livestock
and poultry management; animal transport; wildlife health and management; public health and
occupational safety; environmental management; emergency response management; administrative
and financial management; laboratory diagnostics; information technology; statistics and geospatial
analysis; communications, education and training; and national and international trade. Respondents
include veterinarians, animal health technicians, wildlife biologists, laboratory technicians, safety
and training officers, technical support, and budget, contract, and office support.
TYPE OF COLLECTION: (Check one)
[ ] Customer Comment Card/Complaint Form
[ ] Usability Testing (e.g., Website or Software)
[ ] Focus Group

[ ] Customer Satisfaction Survey
[ ] Small Discussion Group
[X] Other: Responder Feedback Survey

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: Debbi A. Donch, Senior Staff Veterinarian, APHIS Veterinary Services (VS)
To assist review, please provide answers to the following questions:
Personally Identifiable Information:
1. Is personally identifiable information (PII) collected? [ ] Yes
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[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 [ ] No
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
Participation
Respondents Time

State, Local, or Tribal governments

20

Totals

20

Burden

.5 hours per
response with 20
200 hours
responses per
respondent
.5
200

FEDERAL COST: The estimated annual cost to the Federal government is $6,186
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
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?
[X] Yes [ ] No
If the answer is yes, please provide a description of both below (or attach the sampling plan)? If
the answer is no, please provide a description of how you plan to identify your potential group of
respondents and how you will select them?
Universe and identification of potential respondents: The potential respondent universe for this
HPAI emergency response Responder Feedback Survey is all persons engaged in the HPAI
emergency response activities, including response coordination and management, onsite and
virtual response activities, and response support activities.
Specific categories of potential respondents will be identified as follows:
• Federal responders (VS, APHIS non-VS, USDA non-APHIS, and any other Federal
agency responders) and National Animal Health Emergency Response Corps (NAHERC)
responders are identified using the Resource Ordering & Status System (ROSS)
deployment reports. These responders will be provided the link to the on-line survey by
the APHIS VS Incident Coordination Group (ICG). These responders are exempt from
the Paperwork Reduction Act and are therefore not included in this information collection
request for approval.
• State, local, and Tribal governments and private sector responders are identified and
offered the survey through their respective State, local and Tribal government and private
sector incident management representatives. The appropriate incident management
representatives are provided in the link to the online survey by the VS Incident
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Coordination Group.
Explanation: APHIS manages animal disease emergency response activities through the
National Incident Management System (NIMS) and Incident Command System (ICS). An
APHIS National Incident Coordination Group (ICG) is established. Additionally, the APHIS
Emergency Management Leadership Council (EMLC) is engaged as the Multi-Agency
Coordination (MAC) Group and establishes an APHIS HPAI MAC Group. State, local, and
Tribal government and private sector respondents provide representation to the APHIS HPAI
MAC Group, actively participating in the management and coordination of the resources
they bring, including response persons, to support the emergency response.
Sampling plan for selecting from the potential respondent universe: The emergency response
responder feedback survey will be offered to all responders participating in the HPAI emergency
response activities. Completion of this survey is voluntary and completely anonymous. Therefore,
sampling is a “convenience” sample consisting of all potential emergency responders willing to
complete the survey. Sampling will occur throughout the emergency response incident.
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.

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Instructions for completing Request for Approval under the “Generic
Clearance for the Collection of Routine Customer Feedback”
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 with the request.