Fast Track Generic Form_OCC TA Outcomes

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0970-0401)

TITLE OF INFORMATION COLLECTION: Scale for Assessing the Attainment of Technical Assistance Outcomes

PURPOSE: The purpose of this data collection is to gather voluntary information from state staff and their partners on the extent to which the outcomes of the technical assistance were achieved in states and territories that received tailored technical assistance from the Preschool Development Grant Birth through Five (PDG B-5) Technical Assistance (TA) Center. The PDG B-5 TA Center will use the information to assess and improve tailored TA services to grantees and ensure that the Center is addressing the needs of these states and territories.

DESCRIPTION OF RESPONDENTS: The respondents are staff from any state or territories and staff of their partner organizations who participated in Tailored TA. The scale will be sent to recipients of TA at the end of TA.

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: Paula Bendl Smith, Contracting Officers Representative, PDG B-5, Office of Child Care, ACF

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
Private Sector	9	5 minutes	.75
State, local, or tribal governments	26	5 minutes	2.17
Totals	35		2.92 hrs.

FEDERAL COST: The estimated annual cost to the Federal government is $1,471________

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?

Respondents will be individuals that participate in tailored TA. We expect at least half of 56 U.S. states and territories will request tailored TA (N=23). We expect each state team to have an average of 3 people per state and a 50% response rate.

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

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