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

Forms and Documents

Document Name	Status
Form 0920-1050 2019 Science Ambassador Fellowship Regional Training Workshop Customer Satisfaction Survey Form and Instruction	New
Form 0920-1050 Disaster Response Training Needs Assessment Form and Instruction	New
Office of Scientific Integrity Customer Satisfaction Survey Form	New
Form 0920-1050 CDC Page Info Tab Form and Instruction	New
Form 0920-1050 APIH Fellowship Program Orientation Survey Form	New
Academic Partnerships to Improve Health (APIH) Program Training/Workshop Feedback Survey (January – June, 2019) Form	New
Form 0920-1050 Post-Meeting Survey of Attendees at the 2018 Childhood Lead Poisoning Prevention Annual Cooperative Agreement Recipient's Meeting Form and Instruction	New
Form 0920-1050 Feedback for 2018 Place & Health Conference Form and Instruction	New
Form 0920-1050 2018 Public Health Ethics Forum Form and Instruction	New
Participant Assessment of Science Integrity Branch Trainings Form	New
Form 0920-1050 CDC DataViz Day Needs Assessment Form and Instruction	New
Form 0920-1050 2018 Science Ambassador Fellowship Exit Satisfaction Survey Form and Instruction	New
2018 CUPS/Ferguson Summer Showcase Form	New
2018 Science Ambassador Fellowship Summer Course Satisfaction Survey Form	New
Form 0920-1050 CDC Public Health Emergency Management Fellowship Feedback Form and Instruction	New
Form 0920-1050 National Diabetes Prevention Program Customer Service Center (National DPP CSC) -- Customer Satisfactory Surveys Form and Instruction	New
Form 0920-1050 2018 Federal Select Agents Program Inspection Feedback Survey Form	New
Form 0920-1050 Customer Service Feedback Survey of 2018 EIS Conference Form and Instruction	New
Adapting Clnical Guidelines for the Digital Age Meeting Assessment Form	New
Form 0920-1050 MosquitoNet Surveillance System Focus Group Form and Instruction	New
2018 ITSO Customer Satisfaction Survey Form	New
Form 0920-1050 CDC Fellowships, Internships, and Learning Opportunities GovDelivery Newsletter Customer Satisfaction Survey Form and Instruction	New
Education and Training Services Branch Customer Satisfaction Survey Form	New
Seasonal Flu: Email Updates Satisfaction Survey Form and Instruction	New
Form 0920-17AUP CDC Latent Tuberculosis Infection Mobile App Survey Form and Instruction	New
TB Training and Education Needs Assessment of the US-affiliated Pacific Islands and Hawaii Form	New
Partner Feedback Assessment Of Sexually Transmitted Disease (STD) Clinic Processes For Conducting And Documenting Routine HIV Testing Form and Instruction	New
Form 0920-17ANW 2017 Science Ambassador Fellowship Summer Course Satisfaction Survey Form and Instruction	New
Customer Service Feedback Survey of 2017 EIS Conference Form and Instruction	New
CDC Solve the Outbreak Mobile App Form	New
Form 17WN Special Emphasis Panel (SEP) Peer Review Evaluation Form and Instruction	New
Technical Packages for Violence Prevention Using Evidence-based Strategies in Your Violence Prevention Efforts Online Survey Form	New
ITSO Customer Satisfaction Survey Form and Instruction	New
Form 0920-1050 CDC-INFO Interactive Voice Response Survey Form and Instruction	New
Customer Satisfaction Survey for 5 CDC Laboratories Seeking ISO 17025 Accreditation for Laboratory Quality Form	New
CDC-INFO Email Survey Form	New
CDC Public Health Grand Rounds Audience Satisfaction Survey Form	New
CDC Zika Website Form and Instruction	New
2016 Science Ambassador Workshop Satisfaction Survey Form and Instruction	New
SSB fast track revision.docx Supporting Statement B	2016-05-02
SSA fast track revision.docx Supporting Statement A	2016-05-02
60dayFRN..pdf Supplementary Document	2014-11-24
GenIC Clearance Template.docx Supplementary Document	2014-11-24

IC Document Collections

IC ID	Document Title	Status
235100	2019 Science Ambassador Fellowship Regional Training Workshop Customer Satisfaction Survey Form and Instruction	New
234909	Disaster Response Training Needs Assessment Form and Instruction	New
234903	Understanding the Use of CDC Resources and Tools during 2017 Hurricane Disaster Response Other-WORD (English)	New
234900	Office of Scientific Integrity Customer Satisfaction Survey Form	New
234834	CDC Page Info Tab Form and Instruction	New
234727	APIH Fellowship Program Orientation Survey Form	New
234678	Web Usability Study for CDC's Radiation Emergencies Website Other-WORD	New
234628	Academic Partnerships to Improve Health (APIH) Program Training/Workshop Feedback Survey (January – June, 2019) Form	New
234516	Post-Meeting Survey of Attendees at the 2018 Childhood Lead Poisoning Prevention Annual Cooperative Agreement Recipient's Meeting Form and Instruction	New
233529	Feedback for 2018 Place & Health Conference Form and Instruction	New
233474	Assessing Customer Satisfaction with Health, US Report Other-Interview guide	New
233464	Customer Feedback on CDC CVD Policy Platform Other-WORD	New
232985	2018 Public Health Ethics Forum Form and Instruction	New
232825	Participant Assessment of Science Integrity Branch Trainings Form	New
232760	CDC DataViz Day Needs Assessment Form and Instruction	New
232303	2018 Science Ambassador Fellowship Exit Satisfaction Survey Form and Instruction	New
232216	2018 CUPS/Ferguson Summer Showcase Form	New
231619	2018 Science Ambassador Fellowship Summer Course Satisfaction Survey Form	New
231504	CDC Public Health Emergency Management Fellowship Feedback Form and Instruction	New
231415	Emergency Partners Information Connection (EPIC) Partner Interaction Other-Survey script	New
231398	National Diabetes Prevention Program Customer Service Center (National DPP CSC) -- Customer Satisfactory Surveys Form and Instruction	New
231183	2018 Federal Select Agents Program Inspection Feedback Survey Form	New
230262	Customer Service Feedback Survey of 2018 EIS Conference Form and Instruction	New
230232	Adapting Clnical Guidelines for the Digital Age Meeting Assessment Form	New
230010	CDC Learning Connection Gov D Newsletter Survey Other-Screenshots	New
229959	MosquitoNet Surveillance System Focus Group Form and Instruction	New
229828	CDC Template Navigation Other-Discussion guide	New
229412	2018 ITSO Customer Satisfaction Survey Form	New
229110	CDC Fellowships, Internships, and Learning Opportunities GovDelivery Newsletter Customer Satisfaction Survey Form and Instruction	New
228553	Education and Training Services Branch Customer Satisfaction Survey Form	New
228181	Seasonal Flu: Email Updates Satisfaction Survey Form and Instruction	New
227641	CDC Latent Tuberculosis Infection Mobile App Survey Form and Instruction	New
227258	TB Training and Education Needs Assessment of the US-affiliated Pacific Islands and Hawaii Form	New
227197	Partner Feedback Assessment Of Sexually Transmitted Disease (STD) Clinic Processes For Conducting And Documenting Routine HIV Testing Form and Instruction	New
227101	2017 Science Ambassador Fellowship Summer Course Satisfaction Survey Form and Instruction	New
226545	Customer Service Feedback Survey of 2017 EIS Conference Form and Instruction	New
226008	CDC Solve the Outbreak Mobile App Form	New
225960	Special Emphasis Panel (SEP) Peer Review Evaluation Form and Instruction	New
225691	Technical Packages for Violence Prevention Using Evidence-based Strategies in Your Violence Prevention Efforts Online Survey Form	New
225380	ITSO Customer Satisfaction Survey Form and Instruction	New
225142	CDC-INFO Interactive Voice Response Survey Form and Instruction	New
224757	Customer Satisfaction Survey for 5 CDC Laboratories Seeking ISO 17025 Accreditation for Laboratory Quality Form	New
224698	CDC-INFO Email Survey Form	New
223551	FLU Vaccines Section Usability Testing Instruction	New
222920	CDC Public Health Grand Rounds Audience Satisfaction Survey Form	New
222246	CDC Zika Website Form and Instruction	New
222177	2016 Science Ambassador Workshop Satisfaction Survey Form and Instruction	New

ICR Details

OMB Control No: 0920-1050	ICR Reference No: 201605-0920-001
Status: Historical Active	Previous ICR Reference No: 201411-0920-012
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/09/2016
	Date Received in OIRA: 05/10/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2019	36 Months From Approved	02/28/2018
Responses	206,400	0	17,400
Time Burden (Hours)	60,750	0	11,550
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable the Agency to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the Agency's programs. Revision request to add respondents and burden.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  

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:
	79 FR 24432	04/30/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 27134	05/05/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 47

IC Title	Form No.	Form Name
CDC Fellowships, Internships, and Learning Opportunities GovDelivery Newsletter Customer Satisfaction Survey	0920-1050	Customer Satisfaction Survey: CDC Fellowships, Internships, and Learning Opportunities GovDelivery (GovD) Newsletter - Screenshot
Seasonal Flu: Email Updates Satisfaction Survey	NA	Flu Email Updates Survey
MosquitoNet Surveillance System Focus Group	0920-1050	MosquitoNET Focus Group Discussion Guide
2018 Science Ambassador Fellowship Summer Course Satisfaction Survey	n/a	2018 Science Ambassador Fellowship Summer Course Satisfaction Survey
National Diabetes Prevention Program Customer Service Center (National DPP CSC) -- Customer Satisfactory Surveys	0920-1050	National DDP Customer Service Center -- Surveys Along the Customer Journey
CDC Zika Website	NA, NA	ZIKA USABILITY TEST: NOTETAKING DOCUMENT ,   CDC Zika website User Experience (UX): Questionnaire
CDC-INFO Email Survey	none	CDC-INFO Email Survey
2018 Public Health Ethics Forum	0920-1050	PHE Forum Survey
Education and Training Services Branch Customer Satisfaction Survey	none	Customer Satisfaction Survey
Participant Assessment of Science Integrity Branch Trainings	none	Training Assessment
Understanding the Use of CDC Resources and Tools during 2017 Hurricane Disaster Response
2018 CUPS/Ferguson Summer Showcase	none, none, none	Session 2 survey ,   Session 1 survey ,   Session 3 survey
CDC Public Health Emergency Management Fellowship Feedback	0920-1050	PHEMF Feedback
ITSO Customer Satisfaction Survey	NA, NA	2017 ITSO Customer Satisfaction Survey - Domestic ,   2017 ITSO Customer Satisfaction Survey - Global
CDC Solve the Outbreak Mobile App	N/A, N/A, N/A	Solve the Outbreak (General Public version) ,   Solve the Outbreak (Teacher version) ,   Solve the Outbreak (Student version)
2016 Science Ambassador Workshop Satisfaction Survey	NA	2016 Science Ambassador Workshop Satisfaction Survey
2018 Science Ambassador Fellowship Exit Satisfaction Survey	0920-1050	Science Ambassador Fellowship Exit Satisfaction Survey - Screenshot
Disaster Response Training Needs Assessment	0920-1050	Needs Assessment
TB Training and Education Needs Assessment of the US-affiliated Pacific Islands and Hawaii	none, none	TB Survey - word ,   TB Survey - screenshots
2018 Federal Select Agents Program Inspection Feedback Survey	0920-1050	2019 Federal Select Agent Program Inspection Feedback Survey
CDC Public Health Grand Rounds Audience Satisfaction Survey	none	Public Health Grand Rounds Survey
Assessing Customer Satisfaction with Health, US Report
APIH Fellowship Program Orientation Survey	0920-1050, 0920-1050	APIH - ASPPH ORIENTATION SURVY ,   APIH - AACN ORIENTATON SURVEY
CDC Latent Tuberculosis Infection Mobile App Survey	0920-17AUP, 0920-17AUP, 0920-17AUP	Attachment A_LTBI Mobile App Survey Questions ,   Attachment B_LTBI Mobile App Survey_Current Users_Screenshots ,   Attachment C_LTBI Mobile App Survey_Potential Users_Screenshots
Adapting Clnical Guidelines for the Digital Age Meeting Assessment	none	Assessment
Emergency Partners Information Connection (EPIC) Partner Interaction
Customer Feedback on CDC CVD Policy Platform
Office of Scientific Integrity Customer Satisfaction Survey	none	Customer Satisfaction Survey
Customer Service Feedback Survey of 2017 EIS Conference	NA	2017 EIS Conference Customer Service Feedback Survey - Screenshot
2017 Science Ambassador Fellowship Summer Course Satisfaction Survey	0920-17ANW, 0920-17ANW	Att_1_0920-1050_2017_Science_Amb_Fwshp_Sum_Course_Cust_Sat_Survey_Subm ,   Att_2_0920-1050_2017_Science_Amb_Fwshp_Sum_Course_Cust_Sat_Survey_Screen...
2018 ITSO Customer Satisfaction Survey	none	2018 ITSO Customer Satisfaction Survey
CDC Template Navigation
Customer Service Feedback Survey of 2018 EIS Conference	0920-1050	EIS Conference Customer Service Feedback Survey - Screenshots
Customer Satisfaction Survey for 5 CDC Laboratories Seeking ISO 17025 Accreditation for Laboratory Quality	N/A, N/A	CDC Laboratory Cusomter Satisfaction Survey (paper version) ,   CDC Laboratory Customer Satisfaction Survey (web version)
Feedback for 2018 Place & Health Conference	0920-1050	Feedback for 2018 Place & Health Conference
Special Emphasis Panel (SEP) Peer Review Evaluation	17WN	Att 1. Instrument_Peer Reviewers' Evaluation Form 3.2.17
Partner Feedback Assessment Of Sexually Transmitted Disease (STD) Clinic Processes For Conducting And Documenting Routine HIV Testing	NA, NA	DSTDP Assessment: HIV testing in SSuN STD Clinics - STD Clinic Provider Interview Guide ,   DSTDP Assessment: HIV testing in SSuN STD Clinics - STD Clinic/Data Manager Interview Guide
CDC Learning Connection Gov D Newsletter Survey	0920-1050	GOV.D Survey Questions
FLU Vaccines Section Usability Testing
CDC DataViz Day Needs Assessment	0920-1050	DataViz Day Needs Assessment
Post-Meeting Survey of Attendees at the 2018 Childhood Lead Poisoning Prevention Annual Cooperative Agreement Recipient's Meeting	0920-1050	0920-1050
Web Usability Study for CDC's Radiation Emergencies Website
CDC-INFO Interactive Voice Response Survey	0920-1050	17FZ
CDC Page Info Tab	0920-1050	CUSTOMER SATISFACTION SURVEY: CDC’S PAGE INFO TAB
Technical Packages for Violence Prevention Using Evidence-based Strategies in Your Violence Prevention Efforts Online Survey	none	Technical Package Violence Prevention Survey
2019 Science Ambassador Fellowship Regional Training Workshop Customer Satisfaction Survey	0920-1050	Science Ambassador Regional Training Workshop Satisfaction Survey
Academic Partnerships to Improve Health (APIH) Program Training/Workshop Feedback Survey (January – June, 2019)	n/a	APIH Training Feedback 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	206,400	17,400	0	189,000	0	0
Annual Time Burden (Hours)	60,750	11,550	0	49,200	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: Burden increase due to anticipating additional collections to absorb discontinuing clearances (0920-1003 and 0920-0998).

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Annual Cost to Federal Government: $55,000

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 05/10/2016

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