Fast Track GenIC Submission Form - RPG Meeting Evaluation Feedback

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

TITLE OF INFORMATION COLLECTION: Regional Partnership Grant (RPG) Meeting Evaluation Feedback

PURPOSE: The purpose of the Regional Partnership Grant (RPG) Meeting Evaluation Feedback form is to collect information from the RPG meeting participants on their meeting experience. The form will collect routine customer feedback from grantees.

The Children’s Bureau awards RPG under Title IV, part B, subpart 2- Promoting Safe and Stable Families, section 437(f) of the Social Security Act (42 U.S.C. 629g(f)). As part of the grant award, grantees are required to participate in grantee meetings. Key staff are required as a condition of award to attend at least one annual meeting as well as a kickoff meeting at the time of award.

RPG grantee feedback will be collected and then analyzed so future meetings meet the needs of the grantees and are responsive in assisting Children’s Bureau in meeting legislative mandates and furthering priorities.

DESCRIPTION OF RESPONDENTS: Respondents are RPG project staff participating in the meetings. Key staff who are required as part of the grant award include project or programmatic leads, key collaborative partner staff, and evaluation staff.

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:_Catherine Luby, Child Welfare Specialist, OCAN, CB

To assist review, please provide answers to the following questions:

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 [ X] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [X ] 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
Grantee meeting attendees	150	.5	75 hrs.
Totals	150	.5	75 hrs.

FEDERAL COST: The estimated annual cost to the Federal government is $2,000 (within an existing contract task)

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?

Respondents will be RPG key staff who attend the RPG meetings. Each meeting attendee will be provided an opportunity to complete the RPG Meeting Evaluation Feedback.

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

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