Fast Track Submission Template

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

TITLE OF INFORMATION COLLECTION: Children’s Bureau 23^rd National Conference on Child Abuse and Neglect (NCCAN) Participant Satisfaction Survey

PURPOSE: The Administration for Children and Families, Administration on Children, Youth, and Families, Children’s Bureau, Office on Child Abuse and Neglect (CB/OCAN) proposes to collect participant satisfaction information from participants for the national conference. The information collected will enable the contractor, Kauffman & Associates, Inc., to evaluate the utility and effectiveness of the speakers, and sessions to improve future events.

DESCRIPTION OF RESPONDENTS:

Respondents will be participants in the conference organized by the Children’s Bureau.

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:_Lauren Fischman, Child Welfare Program Specialist, CB/OCAN

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
Individuals	600	5 minutes (.08 hrs)	48 hrs.
Totals	600	5 minutes (.08 hrs)	48 hrs.

FEDERAL COST: The estimated annual cost to the Federal government is $2,000.

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?

Kauffman and Associates maintains a listserv of 12,000 contacts who receive periodic notices of updates for NCCAN. A convenience sample will comprise the potential group of respondents through their self-selected attendance at the event and voluntary participation in the survey. The listserv members receive a link for online participation in virtual events, which conclude with the voluntary survey. Based on an estimated population of 12,000 listserv members, a representative sample (95% confidence level with a 5% margin of error) would require approximately 373 completed surveys. We anticipate a response rate of five percent (5%), for a total of 600 completed surveys.

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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