View Information Collection Request (ICR) Package
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View Supporting Statement and Other Documents
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:
201802-0920-007
Status:
Historical Active
Previous ICR Reference No:
201505-0920-003
Agency/Subagency:
HHS/CDC
Agency Tracking No:
0920-0953
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:
08/27/2018
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/27/2018
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
08/31/2021
36 Months From Approved
08/31/2018
Responses
154,800
0
229,800
Time Burden (Hours)
39,225
0
57,975
Cost Burden (Dollars)
0
0
0
Abstract:
This collection of information is necessary to enable the CDC/NIOSH to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The types of collections that this generic clearance covers include, but are not limited to: Customer comment cards/complaint forms, Small discussion groups, Focus Groups of customers, potential customers, delivery partners, or other stakeholders, Cognitive laboratory studies, such as those used to refine questions or assess usability of a website, Qualitative customer satisfaction surveys (e.g., post-transaction surveys; opt-out web surveys) and In-person observation testing (e.g., website or software usability tests).
Authorizing Statute(s):
EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
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:
83 FR 12766
03/23/2018
30-day Notice:
Federal Register Citation:
Citation Date:
83 FR 29558
06/25/2018
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
36
IC Title
Form No.
Form Name
2019 NIOSH Centers Grantee Meeting Evaluation Survey
none
Grantee Meeting Evaluation
Barriers to Care Assessment for WTC Health Program Care at MSSM
none
Barriers to Care Assessment
Barriers to Care Assessment for WTC Health Program Care at Mt. Sinai
none, none, none
Member Questionnaire - English
,
Member Questionnaire - Polish
,
Member Questionnaire - Spanish
Course Evaluation for Continuing Education Webinars-WTCHP
Customer Survey for the World Trade Center Health Program Nutrition Department (Stony Brook)
n/a
World Trade Center Health Program Nutrition Survey
EOHSI/Rutgers Clinical Center of Excellence Annual Monitoring Exam Patient Satisfaction Survey
0920-0953
Rutgers Patient Satisfaction Survey 2019
Focus Groups to Obtain Input from Construction Workers and Employers
Focus Groups-retain Employers
0920-0953, 0920-0953
Focus Group Discussion Guide For Employers
,
Focus Group Discussion Guide For Employees
Focus groups to obtain input from construction workers and employers
Interviews to solicit feedback on COVID-19 Worker Factsheets
0920-20OY
Fact sheet testing interview instrument
Member Satisfaction Survey - Stony Brook
none
Member Satisfaction Survey
Mount Sinai WTC Health Program Clinical Center of Excellence After Visit Questionnaire
0920-0953
Telehealth Services Satisfaction Questionnaire
Mount Sinai WTC Health Program Clinical Center of Excellence After Visit Questionnaire
Mount Sinai World Trade Center Health Program Clinical Center of Excellence Annual Satisfaction Survey
0920-0953
WTC Mt. Sinai Medical Center Annual Survey
NORA CRC Cross-Sector Council Questionnaire
0920-0953
Cross-Sector Survey
NYC Health + Hospitals World Trade Center Environmental Health Center Customer Satisfaction Survey
0920-0953
WTC Environmental Health Center Customer Satisfaction Survey
Occupational Data for Health (ODH) Prototype usability testing
0920-0953, 0920-0953, 0920-0953, 0920-0953, 0920-0953, 0920-0953
PRE-TEST DEMOGRAPHIC DATA SURVEY FOR OCCUPATIONAL DATA FOR HEALTH (ODH) PROTOTYPE USABILITY TESTING
,
POST-TEST SURVEY FOR OCCUPATIONAL DATA FOR HEALTH (ODH)
,
Occupational Data for Health (OHD) Phototype Version 3
,
Employment Status & Retirement dates
,
Longest Held Occupation
,
Work History
Occupational Exposure Banding Survey
Patient Satisfaction Survey Stony Brook
0920-0953, 0920-0953
Participation in WTC Health Program at NYUSOM Clinical Center of Excellence
,
Participation in WTC Health Program at NYUSOM Clinical Center of Excellence (Spanish Version)
Patient Satisfaction Survey Stony Brook
0920-0953
Patient Satisfaction Survey
Surveillance Systems Feedback Survey
none
Systems Application Feedback
Survey for webinars hosted by NIOSH ORI
Survey to Solicit Feedback on Expanding Research Partnerships: Federal Govt
n/a
Feedback Survey on the "Expanding Research Partnerships" webinar series
Survey to Solicit Feedback on Expanding Research Partnerships: Individuals
n/a
Feedback Survey on the "Expanding Research Partnerships" webinar series
Survey to Solicit Feedback on Expanding Research Partnerships: Private Sector
n/a
Feedback Survey on the "Expanding Research Partnerships" webinar series
Survey to Solicit Feedback on Expanding Research Partnerships: State/Local/Tribal Govt
n/a
Feedback Survey on the "Expanding Research Partnerships" webinar series
Survey to Solicit Feedback on TA on Worker Safety and Health provided as part of COVID response
none, none
Field TA Survey
,
Virtual TA Survey
Survey to solicit feedback on Extramural Communication Community of Practice Meetings
0920-0953
Extramural Communication Community of Practice-feedback
TWH Webinar Series
0920-0953
Webinar Questions
Telehealth Satisfaction at MSSM
0920-0953
TMH QA Questionnaire
Telehealth Satisfaction at MSSM
0920-0953
Telehealth Satisfaction Survey
Telehealth Satisfaction at Mt. Sinai School of Medicine (MSSM)
n/a
Telehealth Services Patient Satisfaction Questionnaire
Three Occupation-specific Units for the Workplace Violence Course: Focus Group Discussions for the Stand-alone Facilities, Home Health/Social Services, and Emergency Responder Units
n/a
Focus Group Discussion Guide for Online Workplace Violence Prevention Best Practices Courses
Treatment Satisfaction Survey - NYU
none, none
Treatment Satisfaction Survey - English
,
Treament Satisfaction Survey - Spanish
Winch Entanglement Prevention Technology Interviews
0920-0953, 0920-0953
Opening Script and Eligibility Screening Form
,
Representative Question Stems for Interviews
Worker Notification Feedback Survey
0920-0953
Worker Notification Feedback Survey
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
154,800
229,800
0
-75,000
0
0
Annual Time Burden (Hours)
39,225
57,975
0
-18,750
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
Burden reduction due to adjusting for unused hours and planned efforts within NIOSH for next three years.
Annual Cost to Federal Government:
$112,000
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
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.
No
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
Agency Contact:
Shari Steinberg 404 639-4942 sxw2@cdc.gov
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:
06/27/2018