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: Event (Training, Webinar, Presentation, Workshop) Participant Evaluation Form

PURPOSE: The Census Bureau’s Customer Liaison and Marketing Services Office (CLMSO) is planning to evaluate performance to assess customer satisfaction with training events (in-person training, webinars, presentations, workshops). The feedback from this evaluation will help the CLMSO measure effectiveness in meeting customer needs and make appropriate program changes based on evaluation results. In addition, the CLMSO will use the satisfaction index on the Census Bureau’s Balanced Scorecard at the end of each quarter.

DESCRIPTION OF RESPONDENTS:

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:_Rebecca E. Vilky_______________________________________________

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 [ ] 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
Online response from participants	12,000	3 minutes	600 hours
Totals	12,000	3 minutes	600 hours

FEDERAL COST: The estimated annual cost to the Federal government is $720.00 for hosting the survey online.

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?

CLMSO conducts several training events throughout the year (approximately 200). Participants of these training events are either presented the evaluation form online through WebEx, emailed the link to request their feedback, or presented a paper evaluation form for in-person hands-on training.

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

[X ] In-person

[ ] Mail

[ ] Other, Explain

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

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: 7/31/2020

Enclosure 1: Email Template for Evaluation

For each training event, the below email will be sent to the participants of that particular training the next day. The first line of the email will change based on the training title and date of the training.

From: U.S. Census Bureau

To: Participants of Training Events

Subject: Let Us Know How We Did