ACL Gen Qual Research Form

DOCUMENTATION FOR THE GENERIC CLEARANCE
FOR THE COLLECTION OF ACL’s GENERIC CLEARANCE FOR THE
COLLECTION OF QUALITATIVE RESEARCH & ASSESSMENT

TITLE OF INFORMATION COLLECTION:
[ ] INTERVIEWS
[ ] SMALL DISCUSSION GROUPS
[ ] FOCUS GROUPS
[ ] QUESTIONNAIRES
[ ] OTHER (EXPLAIN: )
DESCRIPTION OF THIS SPECIFIC COLLECTION
1. Intended purpose
2. Need for the collection
3. Planned use of the data
4. Date(s) and location(s)
5. Collection procedures
6. Number of collections (e.g., focus groups, surveys, sessions)
7. Description of respondents/participants
8. Description of how results will be used
9. Description of how results will or will not be disseminated and why or why not
AMOUNT OF ANY PROPOSED STIPEND OR INCENTIVE – NONE
BURDEN HOUR COMPUTATION (Number of responses (X) estimated response or
participation time in minutes (/60) = annual burden hours):
Category of Respondent

No. of
Respondents

Participation
Time

BURDEN COST COMPUTATION
Category of
Respondent

No. of
Hourly
Respondents Rate

1

Response
Time

Total

Burden

OTHER SUPPORTING INFORMATION
REQUESTED APPROVAL DATE:
NAME OF CONTACT PERSON:
TELEPHONE NUMBER:
CENTER/OFFICE/DIVISION:

Public Burden Statement:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a
collection of information unless such collection displays a valid OMB control number (OMB
0985-xxxx). Public reporting burden for this collection of information is estimated to average
0,5 hours per response, including time for gathering and maintaining the data needed and
completing and reviewing the collection of information. The obligation to respond to this
collection is voluntary.

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