Fast Track Submission Request Form

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0690-0030)

TITLE OF INFORMATION COLLECTION: Trade Adjustment Assistance for Firms (TAAF) Firm Satisfaction Survey

PURPOSE: Collect the experiences of firms certified through the Trade Adjustment Assistance for Firms program with Trade Adjustment Assistance Centers on a fiscal year basis for fiscal years 2016, 2017 and 2018. Approval is requested for annual surveys to April 30, 2019.

DESCRIPTION OF RESPONDENTS:

Firms that have been certified through the Trade Adjustment Assistance for Firms program within the previous fiscal year.

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.

Business Unit Certification: ORA/TAAD

OCIO Certification: _________________________

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 [ ] 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
Private sector	300	5 minutes	25.00 hr
Totals	300	5 minutes	25.00 hr

The EDA estimates that 100% of the surveys will be submitted electronically. (Based on past experience with customer satisfaction surveys, we expect approximately a 33% response rate based on survey responses. Effectively, the true burden will likely be 33% of the maximum possible rate reported in the table above: Estimated true burden: 8.33 hours.)

FEDERAL COST: The estimated annual cost to the Federal government is a GS-12 step 5 at 30 hours + 30% to account for overhead and other costs: $43.44 + 13.03 = $56.47 (pre-tax) = $1,694.10

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?

EDA maintains a database with information on firms submitting petitions to be certified for Trade Adjustment Assistance to Firms assistance. A query of that database will provide e-mail addresses for firms certified within a certain fiscal year. EDA intends to survey all firms that were certified within the past fiscal year.

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: live poll software

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

3. Line of Business – Economic and Financial

4. Subfunction – Business and Industry Development

5. Number of Respondents for small entity (a small business which is deemed to be one that is independently owned and operated and that is not dominant in its field of operation ) – 100

6. Affected Public (federal government; households and individuals; the private sector; and state and local governments ) – Private Sector

7. Percentage of respondents reporting electronically – 100%

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: 4/30/19

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