RSN Evaluation Generic Template

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

TITLE OF INFORMATION COLLECTION: U.S. Department of Education Reform Support Network TA Assessment (2012)

PURPOSE: The U.S. Department of Education (ED) is committed to understanding the utility and relevance of TA provided to Race to the Top (RTT) States through the Reform Support Network (RSN) in order to inform both service and program improvement in ensuring States achieve their Race to the Top goals as authorized by the American Recovery and Reinvestment Act of 2009 (ARRA), Section 14005-6, Title XIV, (Public Law 111-5). The Reform Support Network provides TA to Race to the Top States through a variety of mechanisms including Communities of Practice, Webinars, Convenings, Product Development, and individualized technical assistance.

In support of RTT States, it is important to ensure that all TA provided through RSN is of high quality, relevant, useful, and helpful as States work towards achievement of their RTT goals. A survey will be administered to TA participants after each TA event and results used to inform future TA and better understand how and when TA is useful to RTT grantees.

This attached TA feedback form is designed to be tailored slightly to fit the TA mode and objectives for each of the estimated 230 TA events that occur annually while collecting similar data across all events that can be used to identify trends for continuous service and program improvement. In order to reduce participant burden, only the first 12 questions on the form and the questions applicable to any specific mode of TA will be used with a maximum of 20 questions for any TA event feedback form and a length of no more than the front and back of one page.

DESCRIPTION OF RESPONDENTS: Surveys will be handed out to participants in-person at face-to-face TA activities such as convenings and electronically for all other appropriate TA events. Respondents will include RTT State Leads, State Education Agency personnel, Local Education Agency personnel and any other participants in Reform Support Network TA activities.

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:__Tate Gould______________________________________________

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
State and Local Education Agency Staff (state/local government)	2130	4 minutes	113.6 hours
Totals	2130	4 minutes	113.6 hours

FEDERAL COST: The estimated annual cost to the Federal government is _$89,091.21_

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?

All participants in TA activities including webinars, convenings, working groups, individualized technical assistance, meetings, and communities of practice will be invited and eligible to respond. While there are not ‘customer lists’ for all TA activities, we will include an open invitation to all participants who have registered (if applicable), are known participants, or who decide to attend any event in person, over the phone, or on-line.

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

[X ] In-person

[ ] Mail

[ ] Other, Explain

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

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