Generic Customer Survey Template

DOCUMENTATION FOR THE GENERIC CLEARANCE

OF CUSTOMER SERVICE SATISFACTION COLLECTIONS

TITLE OF INFORMATION COLLECTION: Race to the Top Teacher and Leader Effectiveness-Standards and Assessment Community of Practice Convening: Building Leadership for Rigorous Instruction

Meeting Evaluation

[X ] SURVEY [ ] FOCUS GROUP [ ] SOFTWARE USABILITY TESTING

DESCRIPTION OF THIS SPECIFIC COLLECTION

1. Intended Purpose

This submission is a request for approval of a data collection activity that will support the improvement of Race to the Top Convenings conducted by the Reform Support Network (the Network) under contract to the U.S. Department of Education (ED). The Race to the Top Convenings are intended to provide Race to the Top grantees with in-person opportunities to share information, tools, and strategies as well as collaboratively problem-solve issues around topics related to education reform.

In this package, we are requesting approval to administer a survey to participants at a convening on October 2, 2012, with the goals of ascertaining:

• the quality and relevance of the convening,

• suggestions for future convenings,

• the usefulness of the sessions, and

• topics, formats, and types of potential technical assistance support.

2. Need for the Collection

There is no existing data that can provide us with information on the utility and relevance of each Race to the Top seminar/meeting. This data collection effort is essential for (a) determining whether the information is perceived as relevant and useful to its intended audience, (b) determining how future seminars might be improved, and (c) identifying needs for future technical assistance support.

3. Planned Use of the Data

The information collected will provide useful data to ED about how to more effectively target and meet the needs of Race to the Top grantees through Race to the Top Convenings. The survey data will allow us to provide targeted follow-up support to Race to the Top grantees.

4. Date(s) and Location(s)

Data will be collected on October 2, 2012 in Washington, D.C.

5. Collection Procedures

All individuals who attend the convening will be asked to voluntarily complete the survey. It will be administered at the end of the event, in hard copy. To help ensure confidentiality, Network Staff will ask participants to place each completed survey in a sealed envelope that will be held in a secure location by the Network. Feedback surveys will not require any names or other identifying information and will not be reported in a way that allows for identification of individual responses.

1. Number of Focus Groups, Surveys, Usability Testing Sessions

This request is for a single survey instrument to be administered at one Race to the Top Seminar on October 2, 2012.

2. Description of Respondents/Participants

The target population of this survey is state/local government employees in attendance at the Convening. The group will consist of approximately 200 individuals. A 90 percent response rate is expected.

6. Procedures for Sampling Methods and Analysis

No sampling methods will be used. Only descriptive summary information will be provided.

[Attach a copy of the proposed collection instrument, e.g., survey questions, focus group script, usability testing plan. If a focus group also includes a survey, include both.]

AMOUNT OF ANY PROPOSED STIPEND OR INCENTIVE

There is no proposed stipend or incentive for completing this survey.

BURDEN HOUR COMPUTATION (Number of responses (X) estimated response or participation time in minutes (/60) = annual burden hours):

Category of Respondent	No. of Respondents	Participation Time	Burden
State/Local Government Employees	180	5 minutes	900 minutes
Totals	180	5 minutes (.083 hours)	900 minutes (15 hours)

BURDEN COST COMPUTATION

There are no cost burdens to respondents.

STATISTICAL INFORMATION

No statistical methods are to be used for this survey.

REQUESTED APPROVAL DATE: September 24, 2011

NAME OF CONTACT PERSON: Tate Gould

TELEPHONE NUMBER: 202-453-7018

MAILING LOCATION:

ED DEPARTMENT, OFFICE: Implementation and Support Unit