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: Feedback on Intensive and On-site Technical Assistance provided by the Office of Child Care’s Tribal Child Care Capacity Building Center (TCBC)

PURPOSE: The Office of Child Care (OCC) provides Tribal Child Care and Development Fund (CCDF) grantees with training and technical assistance (T/TA) through the Tribal Child Care Capacity Building Center (TCBC). TCBC provides T/TA through several different activities: meetings, universal/targeted TA, intensive/onsite TA, etc. To ensure these activities meet the needs of grantees, OCC is proposing to collect feedback from participants in TCBC T/TA activities. Feedback collected from the surveys will be used internally as a component of TCBC’s continuous quality improvement efforts. Feedback will be used to improve the content of and dissemination approaches for T/TA activities.

This current request is to request feedback on intensive and on-site TA events such as site visits, individualized consultation, and ongoing, long-term engagements. These TA opportunities are offered to Tribal CCDF grantees throughout the year depending on grantee need and OCC priorities for CCDF administration.

DESCRIPTION OF RESPONDENTS:

Respondents will be Tribal CCDF grantees that receive intensive or on-site TA provided by TCBC.

TYPE OF COLLECTION:

[ ] 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 primary purpose of the results is not for public dissemination.

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 and affiliation: Stacy Cassell, Child Care Program Specialist, Office of Child Care

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 [ ] 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

The following burden estimates are annual estimates for 65 on-site and 80 intensive TA engagements per year.

Information Collection	Category of Respondent	No. of Respondents	No. of Responses per Respondent	Estimated Time per Response	Burden Hours
Intensive and On-site TA Feedback Survey	Tribal Government	485	1	10 minutes	81

FEDERAL COST: The estimated annual cost to the Federal government is $28,400.

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?

The respondents will be recipients of intensive and on-site technical assistance provided by TCBC. Survey completion is optional and is provided following technical assistance activities.

The respondents will be identified from webinar registration lists or attendee information provided as part of universal and targeted technical assistance events. All TA recipients will be prompted to complete the survey following TA events. Survey completion is optional.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[ ] Telephone

[X] In-person

[ ] Mail

[X] Other, Explain The survey will be available electronically via SurveyMonkey.

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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