Request for Approval

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-1009)

TITLE OF INFORMATION COLLECTION:

Customer feedback interviews with state-level implementers of “Return to Learn”

PURPOSE:

The National Center for Injury Prevention and Control (NCIPC) promotes the prevention, recognition, and management of Traumatic Brain Injury (TBI). The NCIPC research agenda directs staff to understand the effects of state, community, and organizational protocols which aim to enhance the recognition and management of concussions.

The goal of this project is to assess the implementation of return-to-learn (RTL) procedures and processes, and to determine related best practices, successes and challenges. The information collected will assist the NCIPC TBI team in developing and disseminating future products (e.g., an implementation toolkit) to assist current and future customers such as schools, school districts, state departments of education, and others from private sector with return-to-learn practices for the recognition and management of concussions.

DESCRIPTION OF RESPONDENTS:

Key informants within a sample of states stratified by presence of Return to Learn practices; no Return to Learn practices; and availability and use of voluntary programs (e.g., BrainSteps, REAP). Key informants include state and school district employees charged with implementation of return-to-learn practices for the recognition and management of concussions, developers of informal return-to-learn processes; and experts on cognitive recovery and returning to a classroom environment after concussion.

Customers are current and future implementers of return to learn protocols. Potential respondents will be invited to participate via email (Attachment A). Participation is completely voluntary.

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 discussion

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:__________Karen Angel______________________________________

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 [X ] 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? [ ] Yes [ X] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time (Hours)	Burden (Hours)
State or local government workers	20	45/60	15
Private sector	10	45/60	8
Totals	30		23 hours

FEDERAL COST: $3,876

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? [] Yes [X] 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?

Customers are current and future implementers of return to learn protocols. We will identify and select responders according to the following:

For key informants in states with RTL practices: We will identify state departments of education or individual school districts, and will detect potential responders (listed staff, contacts, or directors of particular departments). We will send invitation emails (Attachment A) to informants identified in 7 of these states.

For key informants in states without codified RTL practices: We will identify interviewees through internet research and through referrals from colleagues and other interviewees. We will send invitation emails to individuals in at least 5 of these states.

For key informants in states with informal RTL practices /programs: Using referrals and information from our assessment team’s network of colleagues, as well as Internet research, we will identify the directors, developers, and/or heads of established and widely disseminated return-to-learn programs. We will send invitation emails (Attachment A) to individuals from each of these programs.

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

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