Program Evaluation Instruments - Roster Program Services (Two Instruments)

Forms and Documents

Document Name	Status
Form 3320-0005(1) Evaluation of Roster Program (Referral Searcher) - IC for Federal Respondents Form and Instruction	Modified
Form 3320-0005(2) Evaluation of Roster Program (Roster Member) - IC for Private Sector Respondents Form and Instruction	Modified
Form 3320-0005(2) Evaluation of Roster Program (Roster Member) - IC for State, Local and Tribal Govt. Respondents Form and Instruction	Modified
Form 3320-0005(2) Evaluation of Roster Program (Roster Member) - IC for Federal Respondents Form and Instruction	Modified
Form 3320-0005(1) Evaluation of Roster Program (Referral Searcher) - IC for Individual or Household Respondents Form and Instruction	Modified
Form 3320-0005(1) Evaluation of Roster Program (Referral Searcher) - IC for Private Sector Respondents Form and Instruction	Modified
Form 3320-0005(1) Evaluation of Roster Program (Referral Searcher) - IC for State, Local and Tribal Govt. Respondents Form and Instruction	Modified
Supporting Statement A and B_Roster Services 33200005_11 14 11.pdf Supporting Statement B	2011-11-15
Supporting Statement A and B_Roster Services 33200005_02 03 2012.pdf Supporting Statement A	2012-02-10

IC Document Collections

IC ID	Document Title	Status
35887	Evaluation of Roster Program (Referral Searcher) - IC for Federal Respondents Form and Instruction	Modified
185859	Evaluation of Roster Program (Roster Member) - IC for Private Sector Respondents Form and Instruction	Modified
185858	Evaluation of Roster Program (Roster Member) - IC for State, Local and Tribal Govt. Respondents Form and Instruction	Modified
185857	Evaluation of Roster Program (Roster Member) - IC for Federal Respondents Form and Instruction	Modified
185856	Evaluation of Roster Program (Referral Searcher) - IC for Individual or Household Respondents Form and Instruction	Modified
185855	Evaluation of Roster Program (Referral Searcher) - IC for Private Sector Respondents Form and Instruction	Modified
185854	Evaluation of Roster Program (Referral Searcher) - IC for State, Local and Tribal Govt. Respondents Form and Instruction	Modified

ICR Details

OMB Control No: 3320-0005	ICR Reference No: 201012-3320-007
Status: Historical Active	Previous ICR Reference No: 200807-3320-012
Agency/Subagency: MKU-SLUF	Agency Tracking No: 0005
Title: Program Evaluation Instruments - Roster Program Services (Two Instruments)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/10/2012
	Date Received in OIRA: 11/15/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2015	36 Months From Approved	02/29/2012
Responses	550	0	600
Time Burden (Hours)	32	0	51
Cost Burden (Dollars)	0	0	0

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Abstract: As part of its program evaluation systems, 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:
	76 FR 44611	07/26/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 63661	10/13/2011
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 7

IC Title	Form No.	Form Name
Evaluation of Roster Program (Referral Searcher) - IC for Individual or Household Respondents	3320-0005(1)	Roster Services - Searcher Questionnaire (Rev 2012)
Evaluation of Roster Program (Referral Searcher) - IC for Federal Respondents	3320-0005(1)	Roster Services - Searcher Questionnaire (Rev 2012)
Evaluation of Roster Program (Roster Member) - IC for Federal Respondents	3320-0005(2)	Roster Services - Member Questionnaire (Rev 2012)
Evaluation of Roster Program (Roster Member) - IC for State, Local and Tribal Govt. Respondents	3320-0005(2)	Roster Services - Member Questionnaire (Rev 2012)
Evaluation of Roster Program (Referral Searcher) - IC for State, Local and Tribal Govt. Respondents	3320-0005(1)	ster Services - Searcher Questionnaire (Rev 2012)
Evaluation of Roster Program (Referral Searcher) - IC for Private Sector Respondents	3320-0005(1)	Roster Services - Searcher Questionnaire (Rev 2011)
Evaluation of Roster Program (Roster Member) - IC for Private Sector Respondents	3320-0005(2)	Roster Services - Member Questionnaire (Rev 2012)

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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	550	600	0	0	-50	0
Annual Time Burden (Hours)	32	51	0	0	-19	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: The burden estimate for the evaluation instrument has revised.

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Annual Cost to Federal Government: $3,534

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 11/15/2011

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