Generic Template - Real Property Satisfaction Survey

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 1800-0011)

T ITLE OF INFORMATION COLLECTION: Federal Real Property Customer Satisfaction Survey

PURPOSE: The information collected from the grantees will be used as one method to evaluate the Federal Real Property Division’s level of customer service in terms of (1) Program Knowledge, (2) Timeliness of Responses, (3) Professionalism, (4) Communication Skills and (5) Ability to handle grantee Requests.

DESCRIPTION OF RESPONDENTS: Responses will be collected from applicants interested in applying to the public benefit conveyance program for educational purposes. Reponses will also be collected from current grantees that have had property conveyed to them through the public benefit conveyance program.

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:_____LaToya Cannon___________________________________________

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 (N/A)

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ ] No (N/A)

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	Burden
Private Sector	200	5 min/survey	17 hours
Totals	200		17 hours

FEDERAL COST: The estimated annual cost to the Federal government is ___$0 (OM has a license for survey monkey)._________

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?

The survey will be conducted through Survey Monkey. The survey link will be listed in the staff’s signature block which will allow any potential applicant and current grantee to respond.

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

[ ] In-person

[ ] Mail

[ ] Other, Explain

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

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