View Information Collection Request (ICR) Package
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View Information Collection (IC) List
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View Generic ICR - OIRA Conclusion
OMB Control No:
0920-0953
ICR Reference No:
201211-0920-003
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
HHS/CDC
Agency Tracking No:
Title:
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIOSH 2)
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
12/21/2012
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/01/2012
Terms of Clearance:
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
Expiration Date
12/31/2015
36 Months From Approved
Responses
334,500
0
0
Time Burden (Hours)
86,250
0
0
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. This feedback will provide insights into customer or stakeholder perceptions, experiences and expectations, provide an early warning of issues with service, or focus attention on areas where communication, training or changes in operations might improve delivery of products or services. These collections will allow for ongoing, collaborative and actionable communications between the Agency and its customers and stakeholders. It will also allow feedback to contribute directly to the improvement of program management.
Authorizing Statute(s):
PL:
Pub.L. 91 - 596 20
Name of Law: Occupational Safety and Health Act of 1970
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:
75 FR 80542
12/22/2010
30-day Notice:
Federal Register Citation:
Citation Date:
77 FR 61409
10/09/2012
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
15
IC Title
Form No.
Form Name
Fatigue Management Training Module for Emergency Reponders Evaluation
Fatigue Management Training Module for Emergency Responders Evaluation
Fatigue Prevention Training Module Customer Satisfaction and Feedback Survey
None
NIOSH Fatigue Prevention Training Module Survey
Logistics Health Incorporated (LHI)
Long Island WTC Health Program Survey
none
Long Island Patient Satisfaction Survey
Manual of Analytical Methods Customer Satisfaction Survey
none
Manual of Analytical Methods Survey
North Shore LIJ Customer Satisfaction Survey
None
Medical Practice Survey
Survey #2
Survey to Improve Worker Notification Efforts
none
Worker Notification Survey
Survey to Improve Worker Notification Efforts #3
none
Survey to Improve Worker Notification Efforts - #3
The Nationwide Provider Network Customer Satisfaction Survey
The World Trade Center Health Program Customer Satisfaction Survey
0920-0953, 0920-0953
WTC Customer Satisfaction Survey
,
WTC screen shots
The World Trade Center Health Program for Responders at Rutgers University Customer Satisfaction Survey
0920-0953
Patient Satisfaction Survey-Rutgers 12.10.13
World Trade Center (WTC) Health Program General Responder Consortium (GRC) Outreach Survey
None
World Trade Center Health Program Member Questionnaire
World Trade Center (WTC) Health Program General Responder Consortium (GRC) Outreach Survey (Spanish and Polish versions)
None, None
Members in the WTCHP General Responders Consortium--Spanish Version
,
Members in the WTCHP General Responders Consortium Polish Version
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
334,500
0
0
334,500
0
0
Annual Time Burden (Hours)
86,250
0
0
86,250
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:
This is a new Generic clearance request.
Annual Cost to Federal Government:
$72,272
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
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
Agency Contact:
Carol Walker 4046394773
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:
11/01/2012
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