NCCC Parents Educators Submission Template

Request for Approval under the “Generic Clearance for the Collection of
Routine Customer Feedback” (OMB Control Number: 3045-0137)
TITLE OF INFORMATION COLLECTION: AmeriCorps NCCC Parents & Educators
Webinar Follow-up Survey
PURPOSE: To collect feedback from participants on the delivery of the team’s recruitment
webinars. Responses to the survey will inform revisions and the team’s future webinars. The
overall objective is to provide the most useful and relevant information for parents and
educators of 16-26-year-olds so they may be able to help spread the word about AmeriCorps
NCCC’s opportunities.
DESCRIPTION OF RESPONDENTS: Attendees of the Parents & Educators webinars.
Ideally, these individuals will be parents, teachers, professors, guidance counselors, career
advisors, or youth leadership development professionals who regularly influence the
career/education decisions of 16-26-year-olds. These individuals may also have been receiving
information in the form of regular email bulletins from the NCCC marketing and recruitment
team for a period of time.
TYPE OF COLLECTION: (Check one)
[ ] Customer Comment Card/Complaint Form
[ ] Usability Testing (e.g., Website or Software
[] Focus Group

[ X ] Customer Satisfaction Survey
[ ] 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.
Name: Jacqueline Dulude______________________________

JACQUELINE
DULUDE

Digitally signed by JACQUELINE
DULUDE
Date: 2020.11.27 14:45:23 -05'00'

To assist review, please provide answers to the following question:
Personally Identifiable Information:
1. Is personally identifiable information (PII) collected? [ X ] Yes* [] 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
N/A

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*If a participant indicates they would like to speak with someone individually about how their
organization can partner with AmeriCorps NCCC, that individual’s phone number/email address
will be collected for the purposes of reaching out. After the individual has been contacted and
had their questions sufficiently answered, their PII will no longer be retained.
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

Individuals or households
Totals

400 annually
400

5 min
5 min.

33.33 hrs. annually
33.33 hrs.

FEDERAL COST: The estimated annual cost to the Federal government is __$1,085______
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?
We will utilize the final attendance report for each webinar. The platform Zoom takes this list
and automatically links participants to a feedback survey immediately after the webinar. The
survey will be sent to 100% of participants.
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.

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