IC Template

Request for Approval under the “GENERIC CLEARANCE FOR QUALITATIVE
CONSUMER EDUCATION, ENGAGEMENT, AND EXPERIENCE INFORMATION
COLLECTIONS”

(OMB Control Number: 3170-0036)
1. TITLE OF INFORMATION COLLECTION:
Survey on Program Activities for YES Initiative
2. PURPOSE:
The surveys track the activities of the participant organizations in the Youth Employment
Success (YES) technical assistance initiative. This information is being collected to help the
CFPB improve technical assistance on integrating financial capability services to youth
employment programs. CFPB and its contractor will review responses to identify potential
enhancements to the materials and trainings. The survey instruments are intended to capture
activities relating to and potential outcomes of integrating financial capability services such as
instruction about savings, financial products, and credit management into youth employment
programs. The information collected from these instruments will be used to share best practices
and refine financial capability tools for the broader workforce system in the coming years and to
help provide improved technical assistance that is targeted to the needs of communities.
3. DESCRIPTION OF RESPONDENTS:
Respondents include youth employment program managers and coordinators from 24
municipalities. Some respondents include city staff and some will be nonprofit staff, depending
on the structure of the workforce program and the workforce activities.
4. TYPE OF COLLECTION (ADMINISTRATION OF THE INSTRUMENT):
a.

How will you collect the information? (Check all that apply)
[X] Web-based or other forms of Social Media
[ ] In-person
[ ] Small Discussion Group
[ ] Other, Explain ______________________

[ ] Telephone
[X] Mail
[ ] Focus Group

b. Will interviewers or facilitators be used?
[ ] Yes [X] No [ ] Not Applicable
5. FOCUS GROUP OR SURVEY:
If you plan to conduct a focus group or survey, please provide answers to the following
questions:
a. 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?
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[X] Yes [ ] No [ ] Not Applicable
b. If the answer is yes, please provide a description below. 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 respondents will be the representatives of organizations or municipal agencies receiving
technical assistance through the YES initiative.
6. INFORMATION COLLECTION PROCEDURES
Please summarize the procedures that will be used to collect data from respondents.
Representatives of organizations or municipal agencies participating in YES will be
surveyed on their program activities as they relate to integrating financial capability
services into their youth employment programs.
We will ask participants to report on their activities at three times throughout the year,
covering the following periods:
• January 1 – May 31, due June 30
• June 1 – August 31, due September 30
• September 1 – December 31, due January 31
The surveys will be provided to YES participants both in a web-based survey that can be
submitted electronically, using the Qualtrics survey platform, and in paper form that can
either be mailed or emailed to CFED. Programs can opt to complete and submit which ever
format they find more convenient.
7. PERSONALLY IDENTIFIABLE INFORMATION:
a. Is personally identifiable information (PII) collected? [ ] Yes [X] No
b. If Yes, is the information that will be collected included in records that are subject
to the Privacy Act of 1974? [ ] Yes [ ] No [X] Not Applicable
c. If Applicable, has a System or Records Notice (SORN) been published?
[ ] Yes [ ] No [ ] Not Applicable
If yes, cite the SORN.
Title:___N/A________________________
___ FR __N/A__________.

d. If applicable, what is the link the Privacy Impact Assessment (PIA)? N/A
8. INCENTIVES:
a. Is an incentive provided to participants? [ ] Yes [X] No
b. If Yes, provide the amount or value of the incentive? $____N/A____.
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c. If Yes, provide a statement justifying the use and amount of the incentive.
N/A
9. ASSURANCES OF CONFIDENTIALITY:
a. Will a pledge of confidentiality be made to respondents? [ ] Yes [X] No
b. If Yes, please cite the statue, regulation, or contractual terms supporting the pledge. N/A

10. JUSTIFICATION OF SENSITIVE QUESTIONS (if applicable): N/A

11. BURDEN HOURS:
Information Collection

Number of
Respondents

Mail or web survey

24
Totals

24

Frequency

3 times per year
/////////////////

Number of
Annual
Responses
72
72

Response
Time
(hours)

Burden
Hours

.5

36

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12. FEDERAL COST: The estimated annual cost to the Federal government is $_10,000_.

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13. CERTIFICATION:
CERTIFICATION PURSUANT TO 5 CFR 1320.9, AND THE RELATED PROVISIONS
OF 5 CFR 1320.8(b)(3) :
By submitting this document, the Bureau certifies the following to be true:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It uses plain, coherent, and unambiguous terminology that is understandable to
respondents;
(d) Its implementation will be consistent and compatible with current reporting and
recordkeeping practices;
(e) It indicates the retention period for recordkeeping requirements;
(f) It informs respondents of the information called for under 5 CFR 1320.8(b)(3):
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(g) It was developed by an office that has planned and allocated resources for the efficient
and effective management and use of the information to be collected;
(h) It uses effective and efficient statistical survey methodology; and
(i) It makes appropriate use of information technology.

CERTIFICATION FOR INFORMATION COLLECTIONS SUBMITTED UNDER A
GENERIC INFORMATION COLLECTION PLAN
By submitting this document, the Bureau certifies the following to be true:
 The collection is voluntary.
 The collection is low-burden for respondents.
 The collection is non-controversial and does not raise issues of concern to other federal
agencies.
 Information gathered will not be used for the purpose of substantially informing influential
policy decisions.
 The collection is not statistically significant; the results are not intended to be generalizable
beyond the survey population.
 The results will not be used to measure regulatory compliance or for program evaluation.

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