Generic Supp Stmnt - VA Homeless Program - Customer Feedback Survey

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 2900-0770)

TITLE OF INFORMATION COLLECTION:

VA Homeless Programs – Customer Feedback Survey

PURPOSE: The purpose of this data collection is to solicit feedback from visitors to “VA.gov/homeless” about their perceptions of VA programs for homeless Veterans. The information collection will also seek their recommendations on how to improve outcomes for Veterans who are homeless or at risk of homelessness.

DESCRIPTION OF RESPONDENTS: The universe of potential respondents includes individuals who fall into one or more of the following categories:

• General public (with only a basic understanding of VA programs for homeless Veterans);

• Veterans, including those who are currently homeless, formerly homeless, or at-risk of homelessness;

• Individuals affiliated with organizations that provide supportive services to homeless Veterans, including organizations that receive funding from VA and those that do not; and

• Individuals interested in providing homeless services to Veterans.

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 [X] Other: Solicit opinions from people familiar with VHA Homeless Programs

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

(Note: We intend to primarily use the information collected to improve the coordination of care to homeless and at-risk Veterans by VA staff, VA’s grantees, and other partner organizations. We also would like to share strong practices that are that are evidenced from the survey results when we are able to validate the effectiveness of those practices from other means such as direct observation or quantitative methods.)

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, Position Title and Credentials:

Anthony Love, Director of Community Engagement, VHA Homeless Programs Office

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
Respondents who visit website: va.gov/homeless (General Public, Veterans, Current Homeless Service Providers, Potential Future Homeless Service Providers)	~ 18,000	10 mins/respondent	~ 3,000
Totals	~18,000 (2% of 900K website visitors)	10 mins/respondent	~ 3,000 hours

FEDERAL COST: The estimated annual cost to the Federal government is approximately $39,700.

Setup	Hours	Cost	Total
Contractors
Project Manager	2	$125.00	$250.00
Web Developer	6	$75.00	$450.00
Subtotal - Setup	8		$700.00
Monthly Collection
VA Staff
Program Analyst (GS-9)	16	$45.00	$720.00
Program Manager (GS-15)	4	$115.00	$460.00
Contractors (if technical problems arise)
Web Developer	8	$75.00	$600.00
Project Manager	2	$125.00	$250.00
Subtotal - Collection (One Month)	30	$360.00	$2,030.00
Subtotal Collection - (12 Months)	360		$24,360.00
Analysis of Survey Results
Program Analyst (GS-14)	8	$95.00	$760.00
Program Manager (GS-15)	4	$115.00	$460.00
Subtotal - Analysis of Survey Results - Monthly	12	$210.00	$1,220.00
Subtotal - Analysis of Survey Results - Annually	144		$14,640.00
Grand Total (Annual Cost)		$0.00	$39,700.00

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? [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?

Individuals who visit va.gov/homeless will be encouraged to complete our online survey form. An average of 900,000 unique users visit va.gov/homeless each year.

The response rate on external surveys administered by organizations of all sized is generally between 10 and 15%. Since many visitors to our website are seeking information about VA Programs for Homeless Veterans for the first time and our survey assumes that those who respond will be familiar with VHA Homeless Programs, we anticipate the response rate to be even lower, likely 2% or less.

We project that we will receive fewer than 30,000 responses. The results will help to inform further investigation about ways to improve outcomes for homeless and at-risk Veterans.

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

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

Instructions for completing Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”

TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the subject of the request. (e.g. Comment card for soliciting feedback on xxxx)

PURPOSE: Provide a brief description of the purpose of this collection and how it will be used. If this is part of a larger study or effort, please include this in your explanation.

DESCRIPTION OF RESPONDENTS: Provide a brief description of the targeted group or groups for this collection of information. These groups must have experience with the program.

TYPE OF COLLECTION: Check one box. If you are requesting approval of other instruments under the generic, you must complete a form for each instrument.

CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.

Personally Identifiable Information: Provide answers to the questions. Note: Agencies should only collect PII to the extent necessary, and they should only retain PII for the period of time that is necessary to achieve a specific objective.

Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.

BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households;(2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be selected per row.

No. of Respondents: Provide an estimate of the Number of respondents.

Participation Time: Provide an estimate of the amount of time required for a respondent to participate (e.g. fill out a survey or participate in a focus group)

Burden: Provide the Annual burden hours: Multiply the Number of responses and the participation time and divide by 60.

FEDERAL COST: Provide an estimate of the annual cost to the Federal government.

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. Please provide a description of how you plan to identify your potential group of respondents and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.

Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.

Submit all instruments, instructions, and scripts are submitted with the request.

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