Field Representative Exit Questionnaire/Decennial Field Staff Exit Questionnaire

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form BC-1294 Field Representative Exit Questionnaire	Form	Modified	Available
Form BC-1294(D) Decennial Field Staff Exit Questionnaire	Form	Modified	Available
POC FR Questionniare with frequencies.pdf	Supplementary Document	Uploaded 2012-08-10	Available
POC FR Questionnaire Comments.pdf	Supplementary Document	Uploaded 2012-08-10	Available
Supporting StatementB revised Aug 2012.doc	Supporting Statement B	Uploaded 2012-08-10	Available
Supporting StatementA revised Aug 2012.doc	Supporting Statement A	Uploaded 2012-08-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
3428	Field Representative Exit Questionnaire/Decennial Field Staff Exit Questionnaire	Form	Modified	Field Representative Exit Questionnaire
3428	Field Representative Exit Questionnaire/Decennial Field Staff Exit Questionnaire	Form	Modified	Decennial Field Staff Exit Questionnaire
3428	Field Representative Exit Questionnaire/Decennial Field Staff Exit Questionnaire	Other-Proposed Changes to BC-1294	Modified

ICR Details

OMB Control No: 0607-0404	ICR Reference No: 201205-0607-001
Status: Historical Active	Previous ICR Reference No: 200906-0607-003
Agency/Subagency: DOC/CENSUS	Agency Tracking No:
Title: Field Representative Exit Questionnaire/Decennial Field Staff Exit Questionnaire
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/14/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/25/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2015	36 Months From Approved	08/31/2012
Responses	650	0	2,500
Time Burden (Hours)	84	0	393
Cost Burden (Dollars)	0	0	0

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Abstract: Due to the monetary cost associated with turnover and the potential impact on data quality, the retention of trained field interviewing staff is a major concern for the Census Bureau. The BC-1294, Field Representative Exit Questionnaire, is the instrument we use to collect data from former current survey interviewers. We use the Exit Questionnaire to identify the reasons for interviewer turnover and to determine what the Census Bureau might have done, or can do, to influence interviewers not to leave. The information we collect from former current survey interviewers will allow for better informed management decisions regarding the future field work force and the implementation of more effective retention strategies.

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Authorizing Statute(s): US Code: 13 USC 23
   US Code: 5 USC 3101
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 54732	09/02/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 31306	05/25/2012
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Field Representative Exit Questionnaire/Decennial Field Staff Exit Questionnaire	BC-1294, BC-1294(D)	Decennial Field Staff Exit Questionnaire ,   Field Representative Exit Questionnaire

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	650	2,500	0	0	-1,850	0
Annual Time Burden (Hours)	84	393	0	0	-309	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Due to completion of the 2010 Census there will be fewer respondents.

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Annual Cost to Federal Government: $5,950

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/25/2012

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