Submission Document

Request for Approval

TITLE OF INFORMATION COLLECTION: Partnership Experience Platform (PXP) Project In-Person Interviews

PURPOSE: To determine whether proposed design and function of the Partnership Experience Platform (PXP) website will resonate with the U.S. Census Bureau Partners for the 2020 Decennial Census

DESCRIPTION OF RESPONDENTS: U.S. Census Bureau Partners (See Attachment A)

TYPE OF COLLECTION: (Check one)

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

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [x ] Other: In-person and remote interviews

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: ________________________________________________

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

3. If Yes, has an up-to-date System of Records Notice (SORN) been published?

[ ] Yes [ ] No

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
In-Person or Remote Interviews	50	120 mins	100 hrs.

FEDERAL COST: The estimated annual cost to the Federal government is minimal.

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

In November and December 2016, a U.S. Census Bureau contractor (Accenture Federal Services) plans to conduct no more than 50 interviews within four of the six Decennial Census regions. We will target new and previous Decennial Census Partners. This group of partners includes individuals from: national non-profit associations, community-based organizations, faith-based organizations, media, corporations, state and local government agencies, foundations and charitable organizations, universities and schools and individuals to serve as participants. Participants will be recruited through professional networks and through the Regional U.S. Census Bureau offices. An email will be sent to individuals asking for participation in the study. This recruiting will be conducted through the U.S. Census Bureau and all research will occur on-site as well as remotely leveraging video conferencing at the U.S. Census Bureau.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[ X] Telephone

[X ] In-person

[ ] Mail

[ ] Other, Explain

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

1.      Line of Business – General Government

2.      Subfunction - Central Records and Statistical Mgt.

3.      Number of Respondents for small entity - 0

4.      Affected Public – Individuals and Households; Businesses; For profit and not-for-profit

5.      Percentage of respondents reporting electronically - 0

Please submit all instruments, instructions, correspondences (emails, letters, etc.) to respondents, and scripts as separate documents along with this request document.

Every instrument must have the following displayed –

OMB Control No. 0690-0030

Expiration Date: 6/30/17