Gen IC NCVS

Request for new submission under the “Generic Clearance for the Collection of Qualitative Feedback on Agency Services Delivery”

(OMB Control Number: 1121-0339)

TITLE OF INFORMATION COLLECTION: Pilot test of the Redesigned National Crime Victimization Survey Instrument

PURPOSE:

The survey collects information about the type and amount of crime committed against people in the United States. The U.S. Census Bureau conducts this survey on behalf of the U.S. Department of Justice.

DESCRIPTION OF RESPONDENTS:

Individuals or households

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ x] Usability Testing (e.g., Website or Software) [ ] Small Discussion Group

[ ] Focus Group [ ] Other: (please describe) _

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: Devon Adams

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 [X ] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No

Note: for any privacy related questions regarding your collection, please contact your component’s Senior Component Official for Privacy or the Office of Privacy and Civil Liberties.

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X ] No

If answering yes, you will also need to describe the incentive and provide a justification for the amount.

BURDEN HOURS:

In the provided table, list the following information in each row for the type or respondent for the collection and provide total figures at the bottom for the number of respondents, participation time, and burden.

• Category of respondent – Provide the type or category of individual who will respond to your collection from the following list:

  • Individuals or Household

  • Private Sector

  • State, Local, or Tribal Governments

  • Federal Government

• Number of Respondents – Estimate of the total number of respondents by type/category.

• Participation Time – Estimate of the total amount of time (in minutes) required for participation in a collection by type/category of respondents (e.g. fill out a survey or participate in a focus group).

• Burden – Estimate of the annual burden hours by type/category or respondents.

  • To determine this estimate, multiply the number of respondents by the participation time and divide that figure by 60.

Burden Table

Category of Respondent	No. of Respondents	Participation Time to complete form	Burden
Individuals or Households	7,900	26min	3,484
Totals

FEDERAL COST: The estimated annual cost to the Federal government is $0___

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 SHOT Show event is open to our customer list of approximately 40,000 FFLs. Due to man power and time constraints, the maximum potential participation is 828 completed surveys, which is around 2% of our targeted population. The surveys will be completed on a strictly voluntary basis by event attendees.

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

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ X ] Yes [ x] No

Submit all instruments, instructions, and scripts with the request.

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