Generic Clearance Submission--56th PS Comments June 2012

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 3002-0006)

T ITLE OF INFORMATION COLLECTION:

56^th Plenary Session of the Administrative Conference of the United States

Conference Member Comment Form

PURPOSE:

This form will be used to solicit feedback from members of the Administrative Conference about various aspects of the Conference’s 56^th plenary session, an “Event” held on June 14 and 15, 2012. The questions address logistics, communications, physical facilities and technology used, scheduling, etc. Responses will be used by Conference staff in the planning of future plenary sessions, with the aim of improving service.

DESCRIPTION OF RESPONDENTS:

The respondents will be members of the Administrative Conference, including liaison representatives of various agencies and organizations and senior fellows of the Conference. The majority of respondents are either federal government employees or special government employees.

TYPE OF COLLECTION: (Check one)

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

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

[ ] Focus Group [ ] Other: ______________________

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:___ David Pritzker _____________________________________________

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	No. of Respondents	Participation Time	Burden
Non-government members of the Administrative Conference attending the plenary session (Event)	50	Under 10 minutes	8.33 hours
Totals	50	< 10 minutes	8.33 hours

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? [ ] 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?

Administration of the Instrument

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

[ X] Web-based or other forms of Social Media [e-mail distribution and responses]

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

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

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

3