Generic Clearance Submission Template Argentine Exchange Alumni Survey (7-11 REV).

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 1405-0193)

T ITLE OF INFORMATION COLLECTION: Argentine Exchange Alumni Survey

PURPOSE:

To successfully conduct an alumni outreach program, we need to know what the preferences of the alumni are. By asking simple questions to Argentine Alumni, we will be able to organize the program events and activities for the year. By using this survey we can offer alumni a program in line with what they are expecting from the Public Affairs Section of the US Embassy in Buenos Aires.

DESCRIPTION OF RESPONDENTS:

The respondents are Argentine Alumni of State Department Programs. They participated in past Exchange Programs in the US and now they are part of the community in this country. We work with them to promote public diplomacy and to enhance the effects of their exchange experience.

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: Federico Scremin, Alumni Coordinator, Public Affairs Section, U.S. Embassy Buenos Aires

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

Personally Identifiable Information:

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

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

Respondents are all Argentine citizens, so Privacy Act doesn’t apply.

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
Individual Alumni participants of US Exchange Programs	1000	15 minutes	250 hours
Totals	1000	15 minutes	250 hours

FEDERAL COST: The estimated annual cost to the Federal government is $270_______

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?

They are all alumni participants in previous Argentine Exchange Programs.

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

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

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