Clearance Submission for Public Survey Oak Ridge TN R4 8-23-2013

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 1910-5160)

TITLE OF INFORMATION COLLECTION:

Oak Ridge Site Specific Advisory Board Public Environmental Survey

PURPOSE:

The purposes of the survey are twofold. First, the survey is designed to gather concerns and opinions from the public regarding environmental management issues related to the U.S. Department of Energy’s Oak Ridge Reservation in Oak Ridge, Tennessee. The information will be used to inform discussions of the Oak Ridge Site Specific Advisory Board as it performs its mission to (1) provide meaningful opportunities for collaborative dialogue among the communities surrounding the Oak Ridge Reservation and the DOE Environmental Management (EM) Program, and (2) provide advice and recommendations to DOE-Oak Ridge EM.

The survey is also intended to seek feedback from the public regarding knowledge and perceptions of the advisory board’s activities, per the Federal Advisory Committee Management Final Rule, CFR § 102-3.95(e).

Survey information is to be collected during the months of September and October 2013 via a SurveyMonkey.com website.

DESCRIPTION OF RESPONDENTS:

Members of the public in the seven county region surrounding the Oak Ridge Reservation who have provided their contact information to the Oak Ridge Site Specific Advisory Board.

TYPE OF COLLECTION: (Check one)

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

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

[ ] Focus Group [] Other: Public survey

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:________________________________________________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [] 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 [] No

Burden Disclosure Statement:

Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Records Management Division, IM-23, Paperwork Reduction Project (1910- 5160), U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (1910- 5160), Washington, DC  20503.

BURDEN HOURS:

Category of Respondent	No. of Respondents	Participation Time	Burden
Individuals	75	5 minutes	6.25
Totals

FEDERAL COST: The estimated annual cost to the Federal government is $320.40.

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 [] 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?

The availability of the survey will be advertised in the July edition of the board’s quarterly Advocate newsletter and on the board’s website. We believe the survey participant numbers will be small, reflecting the number of persons in the area who are attentive to board activities, as demonstrated by their participation in any board activities. Because potential respondents will be attentive persons as opposed to a random or representative sample, no sampling plan is necessary. Funds are not available to employ a professional pollster, and the site will be satisfied with feedback from the attentive group.

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

[ ] Other, Explain

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

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

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