Generic Template - How to Report to ED

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

TITLE OF INFORMATION COLLECTION: “How to Report Back to ED”

PURPOSE:

Throughout 2011, Department staff, Secretary Arne Duncan, and his Teaching Ambassador Fellows held over 100 roundtable conversations with teachers around the country. In these roundtables and other activities currently underway, teachers always are appreciative of being asked to be a part of the conversation. As part of a new effort called “A National Conversation to Re-Envision the Teaching Profession,” ED seeks to bring more teachers to the table and encourage their participation in a series of focus group discussions about the future of the teaching profession.

As an initial phase of the National Conversation, ED staff including the Teaching Ambassador Fellows will conduct additional roundtables with teachers around the country. As a second phase of the National Conversation, ED staff will identify at least one participant in each roundtable as an “ED Teacher Leader” who is interested in carrying on the conversation by leading their own roundtables with colleagues using a “Toolkit” provided by the Department. As part of the “Toolkit”, “ED Teacher Leaders” will receive a form entitled “How to Report Back to ED” which provides a template for them to report back to the Department about the number and background of the participants in the “National Conversation” focus group they ran independently as well as some brief notes on some of the opinions and viewpoints expressed by participants during the conversation.

To support this “National Conversation,” ED will also engage the “ED Teacher Leaders” through an enhanced website to allow for more social networking and later invite the “ED Teacher Leaders” to participate in an in-person Summit. These efforts will enable participants to feel a part of a larger community of teachers participating in policy discussion and greatly expand the Department’s outreach to teachers.

DESCRIPTION OF RESPONDENTS:

The Respondents will be “ED Teacher Leaders” who have independently facilitated roundtables with colleagues as part of the “National Conversation to Re-Envision the Teaching Profession” and who are reporting back to ED about the number of participants and feedback and opinions shared by the roundtable participants.

TYPE OF COLLECTION: (Check one)

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

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

[x] 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:_____Laura Ginns__________________

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	No. of Respondents	Participation Time	Burden
ED Teacher Leaders	450	10 min. per participant	75 hours
Totals	450	10 min. per participant	75 hours

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

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

[ ] 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.

Instructions for completing Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”

TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the subject of the request. (e.g. Comment card for soliciting feedback on xxxx)

PURPOSE: Provide a brief description of the purpose of this collection and how it will be used. If this is part of a larger study or effort, please include this in your explanation.

DESCRIPTION OF RESPONDENTS: Provide a brief description of the targeted group or groups for this collection of information. These groups must have experience with the program.

TYPE OF COLLECTION: Check one box. If you are requesting approval of other instruments under the generic, you must complete a form for each instrument.

CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.

Personally Identifiable Information: Provide answers to the questions.

Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.

BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households;(2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be selected.

No. of Respondents: Provide an estimate of the Number of respondents.

Participation Time: Provide an estimate of the amount of time required for a respondent to participate (e.g. fill out a survey or participate in a focus group)

Burden: Provide the Annual burden hours: Multiply the Number of responses and the participation time and divide by 60.

FEDERAL COST: Provide an estimate of the annual cost to the Federal government.

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. Please provide a description of how you plan to identify your potential group of respondents and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.

Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.

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