Template EBB PROMISE

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

T ITLE OF INFORMATION COLLECTION: Promoting Readiness of Minors in Supplemental Security Income (SSI) (PROMISE) Electronic Bulletin Board Discussion

SSA SUB-NUMBER: A-02

DESCRIPTION OF ACTIVITY:

Background: Promoting Readiness of Minors in Supplemental Security Income (SSI) (PROMISE) is a joint initiative of the Social Security Administration (SSA), and other Federal agencies to fund pilot projects in states to promote positive changes in the outcomes of youth with disabilities who receive SSI and their families. Broadly, the purpose of PROMISE is in part to (1) fund pilot projects that have the potential for transformational impacts through making better use of existing resources, improving coordination among programs, and achieving better outcomes for SSI youth and their families; and (2) generate knowledge regarding existing program delivery and outcomes.

SSA, in coordination with the Departments of Education, Labor, and Health and Human Services, are working together to improve outcomes for children who receive SSI as they transition into adulthood. With the goal of improving the outcomes of SSI-recipient children and their families, SSA would like to develop a better understanding of the existing service environments and support structures available to SSI youth, through online discussions with non-organizational representative payees such as custodial parents and guardians.

Goals and Objectives: The goal is to develop a better understanding of the existing service environments and support structures available to assist SSI youth transition to adulthood. The objective is to determine what expectations parents and guardians have for SSI youth and whether these youth are receiving appropriate mentoring/services to transition to independent living.

Methodology: We are proposing to conduct one electronic bulletin board (EBB) with 21 non-organizational representative payees who serve children between the ages of 14 and 17 who receive SSI. Similar to a focus group, which is an in-person discussion, EBB is an online discussion on a specific topic. An EBB brings participants together to discuss their perceptions, opinions, beliefs, and attitudes about specific products, programs, or services.

DESCRIPTION OF RESPONDENTS

TYPE OF COLLECTION: (Check one)

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

[ ] Usability Testing (e.g., Website or Software [X ] 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: Faye Lipsky, Reports Clearance Officer, Social Security Administration

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? [ X ] Yes, $50 per participant. [ ] No Respondents will not be paid for their participation.

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time (minutes)	Burden (hours)
Individuals	21	120	42
Totals	21	120	42

FEDERAL COST: The estimated annual cost to the Federal Government is $5,000.

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? [ X] Yes [ ] 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 participant selection criterion for this research is as follows:

• Non-Organizational Representative Payees who serve children between the ages of 14 and 17 receiving SSI;

• Two voluntary participants from each SSA Region;

• Solicitation for participation from randomly chosen list of 4,000 non-organizational representative payees from all SSA Regions.

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 - Survey Sheet/Questionnaire

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

How will we conduct the survey?

We will conduct one electronic bulletin board discussion group via online.

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

USE OF RESULTS:

SSA will use the results of this EBB to assess the level of satisfaction parents and guardians of SSI youth have with the existing service environment and support structures available to assist SSI youth. The findings from this study will also inform the agency’s subsequent process evaluations by highlighting existing achievements and revealing any gaps in services perceived by parents and guardians who mentor SSI youth as they transition to adulthood.

NAME OF CONTACT PERSON: Deborah A. Larwood

PHONE NUMBER: 410-966-6135

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