Request for Approval

DI-4011 (Rev. 07/2018)
U.S. Department of the Interior

OMB Control. No. 1090-0011
Expiration Date 10/31/2021

REQUEST FOR APPROVAL UNDER THE
“DOI GENERIC CLEARANCE FOR THE COLLECTION OF
QUANTITATIVE FEEDBACK ON AGENCY SERVICE DELIVERY”

See Page 4 for Instructions on Completing This Form
Title of Information Collection

Formative Evaluation of Interpretive Design and Restoration for the Carter G. Woodson Home using Focus Groups
Purpose
The National Park Service (NPS) and the Association for the Study of African American Life and History, Inc. (ASALH) have been working cooperatively
to restore the circa 1870's home of Dr. Carter G. Woodson. The completed site will provide a unique opportunity for visitors to experience the very
place where Dr. Woodson lived and worked as he and ASALH brought African American history to life.
In addition to the restoration of floors 1 through 3 of the Carter G. Woodson Home, which was completed in Phase 1 of the project, the two adjacent
properties will be rehabilitated for public use, office space and interpretive exhibits. Site improvements include the development, fabrication, and
installation of interpretative exhibits; new accessible access and efficient circulation throughout the space.
To that end, the NPS and its architectural and exhibit contractor, Mills + Schnoering Architects, LLC have determined that a formative evaluation to
gather information related to visitor use, experience and expectations will provide the best information to move forward in the exhibit design phase.
Formative evaluations are generally conducted before or during the design stages in order to determine if the directives and content will be understood
by the public as they were intended by the content specialists and designers. Formative evaluations have also been proven to be very effecting in
guiding the development of exhibit interpretive strategies and identifying ways to increase awareness and relevance to a variety of audiences.
This request is to conduct a series of focus groups at the Carter G. Woodson (CAWO) National Historic Site. The intent of the focus groups is to
identify architectural and exhibition techniques that will increase awareness of the impact and modern relevance of Carter G. Woodson’s life and work
and make the Home a responsive and successful resource for the community.
The results from this collection will be used to inform the design and development phase of the restoration process. In order to provide timely feedback
to the design process data that addresses questions raised during the evaluation, the evaluation must be completed by March 16, 2018.

Description of Respondents

See next page

Type of Collection (Check One)
Customer Comment Card/Complaint Form

Customer Satisfaction Survey

Focus Group

Usability Testing (e.g., Website or Software

Small Discussion 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.
Typed Name of Requester
Signature
Date
Jeremy "Bret" Nickels

Bureau ICCO
Recommend
Not Recommended
DOI PRA Program Lead
Approved
Not Approved

10/29/18

FOR USE BY ICC PROGRAM STAFF ONLY
Signature

DOI Tracking Number
2018-NPS-FT20

Signature

Date

Date

signed by JEFFREY PARRILLO
10/29/18
JEFFREY PARRILLO Digitally
Date: 2018.10.29 10:43:03 -04'00'

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Description of Respondents:
The Focus Groups will consist of targeted individuals having experience with similar historic sites and/or their
visitors including: educators, museum/historic site professionals, tour groups, and multigenerational community
members museum/historic site professionals. The list of invitees was compiled based on suggestions from the
project team (NPS, ASALH and contractors), as well as known members of professional and interpretive
associations whose work relates to the project. The group categories are as follows:
1.
Educators: This group will include teaching professionals local to the Washington D.C. area with experience
in methods to reach elementary, middle and high school age students. This category is also important its input on
managing group tours with large numbers of students visiting the site.
2.
Tour group vendors and guides: The opinions of these professionals will be used to gain an understanding
of what makes cultural sites successful and popular parts of their itineraries. This group will be able to provide
insights regarding the best ways to accommodate large groups of scheduled visitors.
3.
Multigenerational community members: This group will consist of individuals, ranging in age from 16 to 80.
Ages 16 and 17 will be accompanied by their parents. The intended purpose is to gather information from local
community members that may have personal stories about Dr. Woodson or who may have lived in the
neighborhood during his lifetime. Additionally, it is important to understand the thoughts and opinions local
community members may have about CAWO being a valuable asset to their community and Washingtonians.
4.
Museum and historic site professionals: This group will be drawn from non-National Park Service staff to
provide comparative experiences related to process and visitor expectations.

DI-4011 (Rev. 07/2018)
U.S. Department of the Interior

OMB Control. No. 1090-0011
Expiration Date 10/31/2021

TO ASSIST REVIEW, PLEASE PROVIDE ANSWERS TO THE FOLLOWING QUESTIONS:
Personally Identifiable Information (Please consult with your Bureau/Office Privacy Act Officer)
1. Will you collect any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)?
No
Yes If “Yes,” please consult with your Bureau/Office Privacy Act Officer.
2. If “Yes”, is the information to be collected included in records that are subject to the Privacy Act of 1974?
No
Yes
3. If applicable, has a System or Records Notice (SORN) been published?
No
Yes If “Yes,” please provide the title and FR citation below:
Title of SORN:
FR Citation for SORN
Gifts or Payments (Please refer to OMB guidance “Questions and Answers When Designing Surveys for Information Collections”)
Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants?
No
Yes If
“Yes”, please describe the incentive and provide a justification for the amount:

Federal Enterprise Architecture (FEA) Business Reference Model (Check only one “Line of Business” and one “Subfunction.”
Refer to OMB guidance “FEA Consolidated Reference Model Document Version 2.3”)
Line of Business
Subfunction
Line of Business
Subfunction
Community and
Social Services
Defense and
National Security
Economic
Development

(Select One)

(Select One)

(Select One)

Correctional
Activities
Disaster
Management

(Select One)

(Select One)

Education

(Select One)

Energy

(Select One)

Environmental
Management

(Select One)

General Science
and Innovation

(Select One)

Health

(Select One)

Homeland Security

(Select One)

Income Security

(Select One)

Intelligence
Operations

(Select One)

(Select One)

Law Enforcement

(Select One)

International Affairs
and Commerce
Litigation and
Judicial Activities

Natural Resources

Recreational Resource Management and Tourism

Transportation

(Select One)

Workforce
(Select
Management
Burden Hour Calculation
Category of Respondent

(Select One)

One)
Number of Annual
Respondents

Number of
Responses Each

Total Annual
Responses

Participation
Time

Total Burden
Hours

48

1

48

1 hour

48 hours

Individuals/Households

Federal Cost: (Consult your Bureau/Office Information Collection Clearance Officer for assistance, if necessary)
The estimated annual cost to the Federal government is $ 12,480.00

, based on: (provide details below)

Non-Federal Employees (Focus group facilitators, based on 8 hrs.)
Project Manager (M+Sa) $890
Exhibit Designer (content) (H+R) $660
Exhibit Designer (content) (H+R) $660
Travel - Transportation and lodging (2) $1,000
Total $12,480

Sample Response to Federal Cost Question:
“If we receive 20 submissions and it takes 30 minutes to process and implement each one, then the total burden is $322.40
assuming a GS-7 step 5 is processing the submissions. Please note, however, that this custom form is a tool meant to accept
submissions in a standard format rather than through the freeform submissions that would otherwise come in by personal email.
Thus the existence of this form actually saves the government money by standardizing submissions and decreasing the workload of
processing each one.”
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DI-4011 (Rev. 07/2018)
U.S. Department of the Interior

OMB Control. No. 1090-0011
Expiration Date 10/31/2021

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the
following questions:
Selection of 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?
No
Yes If “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.
To recruit participants for the focus groups, NACE staff will contact community leaders, tour group operators and local educators and school teachers
via telephone and email, to explain the purpose of the study and to determine availability. A selected group of individuals who have been identified by
the project team as the following:
• Specialist having experience with similar historic sites and/or their visitors,
• Educators specializing in black history themes and content,
• Community members who may have firsthand experiences with Woodson or his era.
The goal is to recruit at least 48 people to participate in 4 focus groups of no more than 12 persons per group. If a target of 48 participants is not met,
the selection process will continue until a target of 48 eligible individuals will agree to participate.

Sample Response to Question 1 Above:
“Participants will self-select by choosing to follow the link to submit a resource. This is really no different than any website’s “Contact
Us” type of link; this submission form is only used by those who want to contribute to the toolkit. The “Submit a resource” link will be
located on the bottom of the toolkit homepage.”
Administration of the Instrument:
2.

How will you collect the information? (Check all that apply)
Web-based or other forms of Social Media

Telephone

Mail

Other:

In-person

Use of Interviewers or Facilitators:
3. Will you use interviewers or facilitators?
No

Yes
PLEASE SUBMIT SURVEY INSTRUMENT, INSTRUCTIONS, AND SCRIPTS WITH YOUR REQUEST.

Page 3 of 4

DI-4011 (Rev. 07/2018)
U.S. Department of the Interior

OMB Control. No. 1090-0011
Expiration Date 10/31/2021

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 and how you will use this information collection. 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, OMB will return the collection as improperly submitted or
they will disapprove your request.
Personally Identifiable Information: Provide answers to the questions.
Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.
Burden Hour Calculation:
•
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. You may select only
one category.
•
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 in minutes 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:
Selection of 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 you will collect the information. 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.
Submission of the Survey Instrument, Instructions and Scripts: You must submit a copy of the survey instrument, including all
associated instructions and scripts. The survey instrument document must show the OMB Control Number 1090-0011 and Expiration
Date 08/31/2018, along with the following Statements:
Paperwork Reduction Act Statement: We are collecting this information subject to the Paperwork Reduction Act
(44 U.S.C. 3501) to [insert brief justification for collection of information]. Your response is voluntary and we will not
share the results publicly. We may not conduct or sponsor and you are not required to respond to a collection of
information unless it displays a currently valid OMB Control Number. OMB has reviewed and approved this survey
and assigned OMB Control Number 1090-0011, which expires ##/##/####.
Estimated Burden Statement: We estimate the survey will take you ## minutes to complete, including time to read
instructions, gather information, and complete and submit the survey. You may submit comments on any aspect of
this information collection to the Information Collection Clearance Officer, [Insert Bureau], [Insert mailing address].”

Page 4 of 4