CISOMBudsman 2014 Annual Conference Evaluation Form

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 1601-0014)

TITLE OF INFORMATION COLLECTION: DHS HQ Citizenship and Immigration Ombudsman (CISOMB) 2014 Annual Conference Evaluation Form.

PURPOSE: To receive customer feedback on the awareness, understanding, attitudes, preferences, and experiences of customers and stakeholders attending the U.S. Department of Homeland Security Office of the Citizenship and Immigration Ombudsman’s fourth annual conference. Feedback will be used to improve existing and future services, presentation products or communication materials related to the annual conference. Participation by respondents is voluntary. The collection does not impose a significant burden on respondents. The collection does not require statistical rigor in order to have practical utility for improving existing or future service deliveries, products, or communication materials; and public dissemination of results is not intended.

DESCRIPTION OF RESPONDENTS: Individuals from various federal, state and local government agencies, and professional, academic, non-profit organizations with a vested interest in immigration topics.

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: RAYMOND G. MILLS, Chief, Special Program DHS HQ CISOMB

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 [X] Not applicable

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ ] No [X] Not applicable

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
Conference attendee (Individuals)	200	5 minutes	1000 minutes 16.6 hours
Totals	200	5	16.6 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? [ ] 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)

[ ] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

X Other, Explain – A one page 8 question survey will be distributed during the conference to all attendees to complete at their discretion during the event. At the end of the event, the completed surveys will be collected and reviewed for feedback to improve the conference experience for next year.

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

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