Fast Track Request

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 2127-0682)

MAYORS' CHALLENGE FOR SAFER PEOPLE AND SAFER STREETS SURVEY

PURPOSE: This is to request the Office of Management and Budget’s (OMB) approve clearance for the information collection entitled, “Mid-Challenge Survey--Mayors' Challenge for Safer People and Safer Streets.” This survey will collect information on the accomplishments of the Mayors' Challenge, and will be used to identify best practices and to improve future DOT outreach to cities.

DESCRIPTION OF RESPONDENTS:

Abstract: Approximately 260 cities are voluntarily participating in the “Mayors' Challenge” and through locally-driven efforts they are improving bike/ped (pedestrian) safety policies, infrastructure, and awareness. This survey will collect information on the accomplishments of the Mayors' Challenge, and will be used to identify best practices and to improve future DOT outreach to cities. Each city has already identified a point-of-contact for the Mayors' Challenge. This survey will be distributed electronically to these POCs through an online survey tool.

Estimated Total Annual Burden Hours: 30 minutes/respondent; Cumulative 130 hours.

Frequency of Collection: Once.

For Further Information Contact: Anthony Burton, Office of Policy, Office of the Secretary, W84-230, Department of Transportation, 1200 New Jersey Avenue, SE, Washington, DC 20590, (202) 366–2278 or anthony.burton@dot.gov (E-mail).    

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: Anthony Burton

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 [X] 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
Cities participating in the “Mayors' Challenge for Safer People, Safer Streets”	260	30 Minutes	130
Totals	260	30 Minutes	130 hours

FEDERAL COST: The estimated annual cost to the Federal government is: $367.00

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? The contracting office will identify all IT related contracts and that will be the targeted audience.

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

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