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

Forms and Documents

Document Name	Status
Year 5 (2020) Customer Satisfaction Survey for the CDC Antibiotic Resistance (AR) Isolate Bank Form and Instruction	New
SEDRIC User Acceptance and Satisfaction Form	New
Year 4 (2019) Customer Satisfaction Survey for the CDC Antibiotic Resistance (AR) Isolate Bank Form and Instruction	New
Form 0920-1071 Acceptability Survey of ARI Campaign for University of Utah Pediatric Clinic Champions Form and Instruction	New
Form 0920-1071 Immigrant, Refugee, and Migrant Health (IRMH) Website Redesign Form and Instruction	New
Survey to evaluate the Nursing Home Infection Preventionist Training Course Form and Instruction	New
Form 0920-1071 Dialysis Event Module Training Needs Assessment Form and Instruction	New
Form 0920-1071 Customer Satisfaction Survey for 2018 UNGA AMR Side Event Form and Instruction	New
Form 0920-1071 Customer Satisfaction Survey for CDC AR Isolate Bank Form and Instruction	New
Form 0920-1071 Tuberculosis Education Materials for Classified Immigrants Form and Instruction	New
Att. B - Generic_Clearance_for_Qualitative_Feedback_Template_Approval_Form[1] NCEZID.docx Supplementary Document	2018-01-04
60-Day FRN 0920-1071 Extension.docx Supplementary Document	2018-01-04
Att. A - Section 301 of the Public Health Service Act (42 USC 241).pdf Supplementary Document	2018-01-04
SSB_0920-1071_Extension_2017.docx Supporting Statement B	2018-01-04
SSA_0920-1071_Extension_2017.docx Supporting Statement A	2018-01-08

IC Document Collections

IC ID	Document Title	Status
242448	Year 5 (2020) Customer Satisfaction Survey for the CDC Antibiotic Resistance (AR) Isolate Bank Form and Instruction	New
238995	SEDRIC User Acceptance and Satisfaction Form	New
236913	Year 4 (2019) Customer Satisfaction Survey for the CDC Antibiotic Resistance (AR) Isolate Bank Form and Instruction	New
236343	Acceptability Survey of ARI Campaign for University of Utah Pediatric Clinic Champions Form and Instruction	New
236079	Immigrant, Refugee, and Migrant Health (IRMH) Website Redesign Form and Instruction	New
235788	Survey to evaluate the Nursing Home Infection Preventionist Training Course Form and Instruction	New
233228	Dialysis Event Module Training Needs Assessment Form and Instruction	New
232787	Customer Satisfaction Survey for 2018 UNGA AMR Side Event Form and Instruction	New
232515	Customer Satisfaction Survey for CDC AR Isolate Bank Form and Instruction	New
231138	Tuberculosis Education Materials for Classified Immigrants Form and Instruction	New

ICR Details

OMB Control No: 0920-1071	ICR Reference No: 201711-0920-019
Status: Active	Previous ICR Reference No: 201503-0920-011
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1071
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/09/2018
	Date Received in OIRA: 01/08/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	36 Months From Approved	06/30/2018
Responses	5,800	0	5,800
Time Burden (Hours)	3,850	0	3,850
Cost Burden (Dollars)	0	0	0

---

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.

---

Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
   US Code: 42 USC 241 Name of Law: The Public Health and Welfare
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 46994	10/10/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 61001	12/26/2017
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 10

IC Title	Form No.	Form Name
Customer Satisfaction Survey for 2018 UNGA AMR Side Event	0920-1071	UNGA 2018 - AMR Side Event Survey and Emails
Survey to evaluate the Nursing Home Infection Preventionist Training Course	NA	Evaluation of the Nursing Home Infection Preventionist Training Course
SEDRIC User Acceptance and Satisfaction	none	SEDRIC User Acceptance and Satisfaction Survey
Tuberculosis Education Materials for Classified Immigrants	0920-1071, 0920-1071, 0920-1071, 0920-1071	Att C_B1 Key Informant Interview Guide ,   Att D_B2 Key Information Interview Guide--MX ,   Att E_B1 Key Information Interview Guide -- US ,   Att F_B2 Key Informant Interview Guide -- US
Acceptability Survey of ARI Campaign for University of Utah Pediatric Clinic Champions	0920-1071, 0920-1071	Provider Acceptibility Survey ,   Champions Acceptability Survey
Year 4 (2019) Customer Satisfaction Survey for the CDC Antibiotic Resistance (AR) Isolate Bank	n/a	Survey and Accompanying Emails
Immigrant, Refugee, and Migrant Health (IRMH) Website Redesign	0920-1071	Usability Testing Script
Customer Satisfaction Survey for CDC AR Isolate Bank	0920-1071	Customer Satisfaction Survey AR Isolate Bank
Year 5 (2020) Customer Satisfaction Survey for the CDC Antibiotic Resistance (AR) Isolate Bank	n/a	YR 5 (2020) Survey and Accompanying Emails
Dialysis Event Module Training Needs Assessment	0920-1071	The Dialysis Event Module Training Needs Assessment

---

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	5,800	5,800	0	0	0	0
Annual Time Burden (Hours)	3,850	3,850	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $50,000

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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

---

Common Form ICR:  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:

(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: 01/08/2018

---