Generic PPR Submission Form - MED Program Indicators

Request for approval under the clearance of the “Generic Performance Progress Report” OMB control Number: 0970-0490

TITLE OF INFORMATION COLLECTION: Office of Refugee Resettlement Microenterprise Development (MED) Program Indicators

PURPOSE: Data will be collected from all recipients of Office of Refugee Resettlement’s (ORR’s) Refugee Microenterprise Development (MED) discretionary grant program to accompany their Semi-Annual, ACF Performance Progress Report (OMB Approval Number 0970-0406). Data indicators track outcomes that provide information about programs’ enrollment, loan disbursements, and economic impact to ORR-eligible small business owners. Performance data will be used to assess recipients’ progress towards meeting programmatic objectives, identifying monitoring and technical assistance needs, and evaluating the overall effectiveness of the ORR MED program.

DESCRIPTION OF RESPONDENTS: (e.g., states or type of non-profit)

MED Program recipients may include various types of non-profit and community-based organizations.

CERTIFICATION:

I certify the following to be true:

1. The collection is in compliance with HHS regulations.

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.

Name and Title: Anastasia Brown, DRS Division Director

To assist OMB review of your request, 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

BURDEN HOURS

Category of Respondent	No. of Respondents	No. of Responses per Respondent (Annual)	Burden Hours per Response	Annual Burden Hours
Recipient Organizations	29	2	2 hours	116 hours
Totals	29			116 hours

FEDERAL COST: The estimated annual cost to the Federal government is no more than $1,585.94. This is based on the approximately 40 hours total spent in the review and data analysis for these surveys by a contracted Senior Functional Analyst who makes approximately $39.65 per hour.

TYPE OF COLLECTION:

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

[X ] Web-based

[ ] E-mail

[ ] Paper mail

[ ] Other, Explain

Please make sure that all instruments, instructions, and scripts are submitted with the request

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