Description to Chicago Model FO Employee and Vistor Feedback Survey

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0960-0788)

TITLE OF INFORMATION COLLECTION:

Chicago Model FO Employee Feedback Survey and Visitor Feedback Survey

PURPOSE:

The Model FO concept will test physical space, furniture, and technology in the Chicago Field Office (FO). Model FO will expand on current technology to create optimum interaction between SSA customers and SSA services; whether face-to-face, remote, or completely

self-service. The combination of innovative space design and emerging technologies will help enhance the customer experience and assist SSA employees with balancing increasing workloads. This project will affect current FO operation customer service processes and self‑help software for Visitor Intake Process Rewrite (VIPr), Self-Help Personal Computer (SHPC), and Video Service Delivery (VSD).

To test the Model FO concept, we created two surveys: one focused on our external visitors and the other on employee feedback. Survey results will gauge our visitors and employees experience and feedback with the new automated features, and will determine where exactly we need to focus and prioritize our immediate attention.

DESCRIPTION OF RESPONDENTS:

All visitors will have the opportunity to provide feedback on a survey. We will survey employees periodically; the frequency of surveys will vary.

TYPE OF COLLECTION: (Check one)

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

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

[ ] Focus Group [] Other: ______________________

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.

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.

Name: Melisa Soto-Gonzalez

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

Personally Identifiable Information:

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

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [X] No

Gifts or Payments:

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

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time (minutes)	Burden (hours)
Individuals	10,000	5	834
Employees that work at the Model FO	40	5	3
Totals	10,040		837

FEDERAL COST: The estimated annual cost to the Federal government is $309.33

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? [ ] Yes [ X] 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?

Chicago Model FO Employee Feedback Survey based on current employee participation. Employees will have an opportunity to provide feedback of their experience with the Model Field Office site.

Visitor Feedback Survey Sample based on the surrounding population that will visit the Chicago Model Field office site. As a baseline, we used 50,000 visitors, which is an estimated number of visitors we captured in FY2017- we optimistically estimate that 20% of the visitors will reply to the paper survey. All visitors will have an opportunity to provide their feedback through a quantitative or qualitative survey method.

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

[X] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [X] No

Initially, we will administer the survey to the public in a paper format. Eventually, we will convert the survey to an electronic format. We will administer these surveys with minimal interaction from front line employees.

The Employee survey can be completed by individual employee with minimal interaction.

Please make sure that all instruments, instructions, and scripts are submitted with the request.

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