G324 Small Business Success Stories Submission Request

Request for Approval under the “Generic Clearance for Improving Customer Experience” (OMB Control Number: 0651-0080)

TITLE OF INFORMATION COLLECTION: G324: Small Business Success Stories

PURPOSE: The purpose of this collection of small business success stories is to highlight how small businesses play an intricate role within the overall operations of the United States Patent and Trademark Office (USPTO).

DESCRIPTION OF RESPONDENTS:

Information will be collected from small business vendors who were awarded a contract from the USPTO.

TYPE OF COLLECTION: (Check one or multiple)

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

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

[ ] Focus Group [X] Other: Questionnaire

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. (partcipants will sign a release)

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.

Business Unit/Name: Office of the Chief Financial Officer, Portia L. Deans

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

Personally Identifiable Information:

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

1a. If Yes, is the information that will be collected included in records that are subject to

the Privacy Act of 1974? [ ] Yes [ ] No

2. If applicable, has a System of Records Notice been published? [ ] Yes [ ] No [X] N/A

Gifts or Payments:

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

BURDEN HOURS

Name of Instrument	No. of Respondents	Participation Time	Burden
Private Sector	25	20 minutes (.33 hours)	8 hours
Totals	25		8 hours

The USPTO estimates that 100% of the surveys will be conducted online.

FEDERAL COST: The estimated annual cost to the Federal government is the combined average hourly rate of $70.45 per hour for a GS-14 step 7 + $21.14(30%) = which totals an hourly rate of $91.59. This multiplied by 8 hours = $733.

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? [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?

Small business venders who have been awarded a contract with the USPTO will invited to complete this voluntary questionnaire.

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

3