Creating an Information Collection Request

Instructions

You must submit a completed Information Collection Request (ICR) form in order to get Fast Track PRA clearance for your UX/CX research.

You can either download the template as a .docx file and complete it manually OR enter your information about your research into the guided ICR Form Builder below. (You do not have to do both.)

After completing the documentation for your project, please follow the remaining steps to submit it.

ICR Form Builder

  1. Details
  2. Description
  3. Burden estimate
  4. Certification
  5. Review

Step 1 of 5 Details of information collection

Title of information collection *
Purpose of collection *
Type of activity *Choose one.
If this is a survey, will the results of this survey be reported to Touchpoints as part of quarterly reporting obligations specified in OMB Circular A-11 Section 280? *Choose one.
How will you collect information? *Please select all that apply.

Who will you collect the information from? *
How will you ask a respondent to provide this information? *
What will the activity look like? *
Please provide your question list *
When will the activity happen? *
Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? *

Select the categories that apply and provide the required information for each.

Category of respondents *

I certify the following to be true *
  • The collections are voluntary;
  • The collections are low-burden for respondents (based on considerations of total burden hours or burden-hours per respondent) and are low-cost for both the respondents and the Federal Government;
  • The collections are non-controversial;
  • Any 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 near future;
  • Personally identifiable information (PII) is collected only to the extent necessary and is not retained;
  • Information gathered is intended to be used for general service improvement and program management purposes;
  • The agency will follow the procedures specified in OMB Circular A-11 Section 280 for the required quarterly reporting to OMB of trust data and experience driver data from surveys.
  • Outside of the quarterly reporting mentioned in the bullet immediately above, if the agency intends to release journey maps, user personas, reports, or other data-related summaries stemming from this collection, the agency must include appropriate caveats around those summaries, noting that conclusions should not be generalized beyond the sample, considering the sample size and response rates. The agency must submit the data summary itself (e.g., the report) and the caveat language mentioned above to OMB before it releases them outside the agency. OMB will engage in a passback process with the agency.

You can preview your completed ICR form below. If you need to make edits, you can go back and do so.

Once you are satisfied with your ICR form, you can download it. You can also go back and make edits.

After downloading, please email the completed form and all instruments (surveys, forms, etc.) to the OMB CX Desk, cc'ing tts-research@gsa.gov and GSARegSec@gsa.gov.

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