Program Evaluation Instruments - Collaborative Problem Solving Facilitation Services (Two Instruments)

Forms and Documents

Document Name	Status
Form 3320-000N(2) Evaluation of Facilitation Services (Practitioner) - IC for Private Sector Respondents Form and Instruction	New
Form 3320-000N(2) Evaluation of Facilitation Services (Practitioner) - IC for Federal Respondents Form and Instruction	New
Form 3320-000N(1) Evaluation of Facilitation Services (Participant) - IC for Individual or Household Respondents Form and Instruction	New
Form 3320-000N(1) Evaluation of Facilitation Services (Participant) - IC for Private Sector Respondents Form and Instruction	New
Form 3320-000N(1) Evaluation of Facilitation Services (Participant) - IC for State, Local and Tribal Govt. Respondents Form and Instruction	New
Form 3320-000N(1) Evaluation of Facilitation Services (Participant) - IC for Federal Respondents Form and Instruction	New
Facilitation_Services_Participant_QuestionnaireFinal 12 12 08.doc Supplementary Document	2008-12-15
Supporting Statement A and B_Facilitation Services NEW_07 25 08.pdf Supporting Statement B	2008-07-31
Supporting Statement A and B_Facilitation Services NEW_07 25 08.pdf Supporting Statement A	2008-07-31

IC Document Collections

IC ID	Document Title	Status
185881	Evaluation of Facilitation Services (Practitioner) - IC for Private Sector Respondents Form and Instruction	New
185880	Evaluation of Facilitation Services (Practitioner) - IC for Federal Respondents Form and Instruction	New
185879	Evaluation of Facilitation Services (Participant) - IC for Individual or Household Respondents Form and Instruction	New
185878	Evaluation of Facilitation Services (Participant) - IC for Private Sector Respondents Form and Instruction	New
185877	Evaluation of Facilitation Services (Participant) - IC for State, Local and Tribal Govt. Respondents Form and Instruction	New
185876	Evaluation of Facilitation Services (Participant) - IC for Federal Respondents Form and Instruction	New

ICR Details

OMB Control No: 3320-0010	ICR Reference No: 200807-3320-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: MKU-SLUF	Agency Tracking No: 000N
Title: Program Evaluation Instruments - Collaborative Problem Solving Facilitation Services (Two Instruments)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/18/2008
	Date Received in OIRA: 07/31/2008
Terms of Clearance: This collection of information is approved for 3 years. The Agency is cautioned that the information collected under this ICR should not be used for program evaluation purposes, but rather to provide feedback to improve facilitation services at the individual service provider level.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2011	36 Months From Approved
Responses	2,250	0	0
Time Burden (Hours)	761	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: As part of its program evaluation system, the U.S. Institute for Environmental Conflict Resolution plans to collect information on the quality of its services from contractors and users of its services.

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Authorizing Statute(s): PL: Pub.L. 105 - 156 5 Name of Law: Environmental Policy and Conflict Resolution Act of 1998
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 15007	03/20/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 44288	07/30/2008
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Evaluation of Facilitation Services (Practitioner) - IC for Private Sector Respondents	3320-000N(2)	Facilitation Services - Practitioner Questionnaire (Paper)
Evaluation of Facilitation Services (Participant) - IC for Individual or Household Respondents	3320-000N(1)	Facilitation Services - Participant Questionnaire (Paper)
Evaluation of Facilitation Services (Participant) - IC for Private Sector Respondents	3320-000N(1)	Facilitation Services - Participant Questionnaire (Paper)
Evaluation of Facilitation Services (Participant) - IC for Federal Respondents	3320-000N(1)	Facilitation Services - Participant Questionnaire (Paper)
Evaluation of Facilitation Services (Participant) - IC for State, Local and Tribal Govt. Respondents	3320-000N(1)	Facilitation Services - Participant Questionnaire (Paper)
Evaluation of Facilitation Services (Practitioner) - IC for Federal Respondents	3320-000N(2)	Facilitation Services - Practitioner Questionnaire (Paper)

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,250	0	0	2,250	0	0
Annual Time Burden (Hours)	761	0	0	761	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: New collection for evaluating facilitation services – Program Change

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Annual Cost to Federal Government: $20,744

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/31/2008

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