Request for Approval

Request for Approval under the “DOI Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery”

(OMB Control Number: 1090-0011)

TITLE OF INFORMATION COLLECTION:

Neal Smith National Wildlife Refuge - Environmental Education Feedback Form

PURPOSE:

We will use this survey as a post-assessment tool following our environmental education programs. We will use the feedback to gauge audience satisfaction with lessons, and to improve/make changes per audience suggestions.

DESCRIPTION OF RESPONDENTS:

Respondents will be teachers participating in the refuge’s partner teacher or partner school programs. They are elementary school teachers using our facility or refuge curriculum with their students. In 2017, 50 teachers participated in the partner teacher and school programs. We are assuming a similar number of teachers will participate annually in the future; staffing limitations limit adding additional teachers in the future. Since this is a voluntary survey, we estimate that about 15% of potential respondents will participate (per survey research). This gives us about 8 total respondents (50 x 0.15 = 8).

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 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: Patrick Bryant, Park Ranger, Neal Smith National Wildlife Refuge, USFWS

To assist review, please provide answers to the following questions:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? Yes 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 If “Yes”, please include the SORN title, number, and Federal Register citation for the publication:

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? Yes No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Total Hour Burden
Individuals/Households	8	5 mins	.67 hour

FEDERAL COST: The estimated annual cost to the Federal government is $106 (rounded)

We calculated this cost based on our estimate of 15 minutes of staff time per respondent required to email/deliver, collect, review, and apply feedback (15 minutes x 8 respondents/ 60 minutes = 2 hours). We then multiplied the 2 hour estimate by the fully burdened hourly pay of $52.85 (OPM table 2018-RUS) for a GS-11/05 employee ($33.24 X 1.59 per BLS News Release USDL-18-0451) = $105.70.

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 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.

Respondents must be participants of the partner teacher or partner school programs. Program participation is regulated by the refuge to a set number per year. Surveys will only be given after a teacher has used refuge facilities or curriculum through the partner teacher or partner school programs.

Administration of the Instrument

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

Web-based or other forms of Social Media

Telephone

In-person

Mail

Other, Explain

2. Will interviewers or facilitators be used? Yes No

Please make sure that all instruments, instructions, and scripts are submitted with the request.

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