Generic Fast-Track Template

Request for Approval under the “Generic Clearance for the Collection of Routine
Customer Feedback” (OMB Control Number: 3133-0188)
TITLE OF INFORMATION COLLECTION: CURE MDI Mentoring Cohort Survey
PURPOSE: The National Credit Union Administration (NCUA) seeks feedback from the credit unions
that participate in Minority Depository Institutions Mentoring Cohort. The participants will be surveyed
four times during a 24-month period: six months into the Cohort (Six-Month Survey), immediately after
the Cohort (12 Month Survey), six months after the Cohort concludes (18 Month Survey), and 12
months after the Cohort concludes (24 Month Survey).
Credit union participants in the MDI Mentoring Cohort program are awardees of targeted technical
assistance grants and their mentors. The purpose of the MDI Mentoring Grant is to help small
institutions establish mentoring relationships with larger low-income, MDI credit unions that can
provide expertise and guidance in serving low-income and minority populations.
Surveying participants six months into the Cohort will help program administrators gauge how well the
activities, resources and expertise offered are helping participants meet their identified needs and grant
objectives, and if adjustments need to be made. Surveying at the end of the Cohort (12 Month Survey)
will help in the planning process for future Cohorts. Surveying six and 12 months after the Cohort (the
18 Month and 24 Month surveys) will help planners determine if the activities, resources and expertise
offered have a lasting impact on Cohort participants, providing information to determine the long-term
impact of the program.
The survey will be available online through the agency’s Learning Management Service or the agency’s
Survey Monkey account.
DESCRIPTION OF RESPONDENTS: Credit unions receiving the Minority Depository Institutions
Mentoring Grant and the credit unions serving as the mentors to those credit unions, will receive an
email invitation to participate in the survey with a link included and instructions on how to access and
answer the survey.
TYPE OF COLLECTION: (Check one)
[ ] Customer Comment Card/Complaint Form
[ ] Usability Testing (e.g., Website or Software
[ ] Focus Group

[ ] Customer Satisfaction Survey
[ ] Small Discussion Group
[X] Other: Customer Feedback Survey

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: ____Dawn D. Wolfgang______________
NCUA PRA Clearance Officer
Program Contact: _ Ron Goode, CURE ______

Date: ____1/05/2021____

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
Private Sector – Minority Depository
Institution Credit Unions (survey)
Private Sector – Federally Insured Credit
Unions (survey)

Totals

No. of
Total
Respondents Responses
10
4

Participation
Time
.25

Burden
Hours
10

10

.25

10

4

20

20

FEDERAL COST: The estimated annual cost to the Federal government is $100__________
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:
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?
The respondents will be identified by the fact that they are a credit union that has been awarded the
Minority Depository Institutions Mentoring Grant or a credit unions that has agreed to be a mentor.
Administration of the Instrument:
1. How will you collect the information? (Check all that apply)
[ ] Web-based or other forms of Social Media
[ ] Mail
[ ] Telephone
[X] Other, Explain: Online survey.
[ ] In-person
2. Will interviewers or facilitators be used? [ ] Yes [X ] No