Generic Template - STLC Participant Feedback Survey

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 1880-0542)

TITLE OF INFORMATION COLLECTION:

School Turnaround Learning Community Feedback Survey

PURPOSE:

The School Turnaround Learning Community launched on July 6, 2011. The goal of the community is to provide states and districts with easy online access to resources and to facilitate networking that will enable them to support schools more effectively. This survey provides feedback to the Office of Elementary and Secondary Education (OESE) staff on the relevance, utility, and meaningfulness of an online community of practice overall and of each webinar/workshop that will be provided within it.

DESCRIPTION OF RESPONDENTS:

Respondents are School Improvement Grant recipients who have registered as members of the online School Turnaround Learning Community.

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: Jennifer Ballen Riccards, 202-205-4274

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, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If applicable, has a System or Records Notice 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	Number of Respondents	Participation Time	Burden
Individual grant recipients	700	10 minutes	116 hours
Totals	700	10 minutes	116 hours

FEDERAL COST: The estimated annual cost to the Federal government is $0.00.

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?

We plan to offer the survey to any member of the online School Turnaround Learning Community. We will post the survey in the community and send an email to everyone to announce the survey link.

Respondents will be School Improvement Grant recipients who choose to participate in the community and webinars hosted by OESE on this Community of Practice website.

Administration of the Instrument

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

[x] Web-based or other forms of Social Media

[ ] 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.

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