HUD-DOJ PFS Key Project Partners (Quarterly Time Use Survey)

Appendix B

Time Use Survey

What is the purpose of the survey?

You are being asked to participate in this survey because of your role in an organization that is involved with the <Site Name>’s Pay for Success Initiative. This component of the evaluation is necessary to understand the additional time costs of PFS beyond what is covered by DRGR reporting. To reduce the organizational burden of the quarterly data collection, only one person from each organization identified will be contacted to provide hours spent by organization staff.

Survey Instructions

This data collection would entail reporting on the number of hours spent by your staff on the <Project Name> in <Site Name>. We will send a spreadsheet to you to record paid staff hours by calendar year quarter. As a reminder, these hours should capture work that is specific to the Pay for Success component of the project. We have attached an example spreadsheet for your reference.

STAFF MEMBERS		Time Period				SOURCES OF INFORMATION
Staff Name	Staff Member Role/Level (ex. Executive, Director, Analyst)	Q1 2025	Q2 2025	Q3 2025	Q4 2025	Where did you find this information (ex. Time card, Calendar, etc.)?

How will my answers be shared?

The information requested under this collection is protected and held private in accordance with 5 U.S.C.552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974) and OMB Circular No. A-130. A Privacy Impact Assessment was approved by the Department on 11/17/2017. There is no data linkage between one data set and another to learn more about an individual so there is no system of records notice (SORN).

Burden Estimate

Quarterly data collection will be conducted four times per year, to approximately 17 respondents in supervisory or administrative positions in partner organization participating in the PFS Demonstration. Estimate of the burden is based on 1 hour to respond each time to the emailed request or to complete an interview.

Questions?

If you have any questions about the survey or have technical difficulties completing the survey, please contact Brendan Chen at the Urban Institute at bchen@urban.org. HUD may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

The Paperwork Reduction Act Statement

This collection of information is voluntary and will be used to evaluate the US Department of Housing and Urban Development’s Community Choice Demonstration. Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB number and expiration date for this collection are OMB #: 2528-0319, Exp: XX/XX/XXXX.