Supporting Statement

Health Resources and Services Administration

SUPPORTING STATEMENT

Bullying Prevention Training Modules Feedback Forms

A. Justification

1. Circumstances of Information Collection

The Health Resources and Services Administration (HRSA) currently has approval under the generic clearance, Office of Management and Budget (OMB) Control No. 0915-0212, to conduct customer satisfaction surveys and focus groups. This collection of information helps fulfill the requirements of:

1. Executive Order 12862, “Setting Customer Service Standards,” which directs Agencies to continually reform their management practices and operations to provide service to the public that matches or exceeds the best service available in the private sector.

This is a request for OMB approval of qualitative voluntary customer satisfaction surveys under HRSA’s generic clearance. HRSA’s Maternal and Child Health Bureau (MCHB) will obtain feedback from consumers of a resource titled Bullying Prevention Training Modules and Community Action Toolkit. Production of this new resource was funded through HRSA’s contract entitled Communications Management Services to Support the HRSA National Bullying Prevention Campaign, contract number GS23F0141L. The statement of work for this current contract includes both the production and dissemination of the training modules project, to include Power Point slides and a step-by-step guide for conducting a community event addressing bullying. This contract has been extended through September 22, 2013.

Executive Order 12862 directs agencies that "provide significant services directly to the public" to "survey customers to determine the kind and quality of services they want and their level of satisfaction with existing services". The objective of surveying the consumers of the Bullying Prevention Training Modules and Community Action Toolkit is to provide insight regarding user opinions, experiences and perceptions of the new resource. This information will inform revision of the product in order to ensure that the target audience’s needs are being effectively met. Target audiences for this resource include community members of all different backgrounds: elected officials, faith leaders, youth leaders, and professionals in education, health and safety, law enforcement, child care and out-of-school care, mental health and social services, local recreation offices, as well as leaders of the local business community.

2. Purpose and Use of the Information

As local communities respond to increased awareness about the negative impact of bullying on youth, they actively seek bullying prevention expertise to provide evidence-informed, accurate information to inform prevention efforts. HRSA’s new Bullying Prevention Training Modules and Community Action Toolkit responds to this need by distilling the latest evidence and expert opinion

3. Use of Improved Information Technology

The surveys will employ technology by being accessible via an online survey application (i.e., Survey Monkey). In addition, the forms will be available for download as a Word document to increase user accessibility. The Word document version will be accepted via email to HRSA’s contractor. In both methods of feedback (online survey and Word document), all data will be extracted and compiled into one spreadsheet for analysis.

4. Efforts to Avoid Duplication

Each survey is designed to collect user feedback at a different stage in the implementation of the Bullying Prevention Training Modules and Community Action Toolkit. Form A will be used immediately after receiving the training while Form B will be used four months later to assess the utility of the resource in planning a community event. Form C will be used immediately after a local community event where the Community Action Toolkit is used, and Form D will be used four months later to assess the utility of the resource among community members who attended a community event. None of the forms are duplicative of any other information collection.

5. Involvement of Small Entities

These surveys will not have a significant impact on small businesses or other small entities.

6. Consequences if Information Collected Less Frequently

Information gathered through these surveys will serve to inform future revisions to the Bullying Prevention Training Module and Community Action Toolkit. If the information from the surveys is not collected, program staff will not be informed as to what revisions/improvements need to be made to the toolkit. There are no legal obstacles to reduce the burden.

7. Consistency With the Guidelines in 5 CFR 1320.5(d)(2)

These surveys will be implemented in a manner fully consistent with 5 CFR 1320.5(d)(2).

8. Consultation Outside the Agency

In accordance with 5 CFR 1320.8(d), on April 24, 2009, a 30-day notice was published in the Federal Register (Vol. 74, Page 18726) for HRSA’s generic clearance, OMB Control No. 0915-0212. No public comments were received.

9. Remuneration of Respondents

Respondents are not remunerated.

10. Assurance of Confidentiality

This proposed collection of information will involve the names of respondents, their email address and their organization’s name in order to conduct follow up outreach using Forms B-D included in this package. This collection will fully comply with all aspects of the Privacy Act, and will be conducted by HRSA’s contractor. Participation is fully voluntary, and personally identifiable information will not be shared with HRSA staff. Respondents will be assured that neither their participation/non-participation nor any responses to items will have any effect on their participation in HRSA programs. All raw data will be destroyed.

11. Questions of a Sensitive Nature

The surveys do not contain questions of a sensitive nature.

12. Estimates of Annualized Hour Burden

Respondents:

The total respondent burden for the customer satisfaction surveys is estimated to be 175 hours. We expect a total of 700 respondents to use the Bullying Prevention Training Module and Community Action Toolkit and to provide user feedback: 50 respondents from the pool of individuals that access the resource (both immediately after training and at 4 months for follow- up), and 300 respondents who attend a community event employing the resource (both immediately after the event and at 4 months for follow-up).

Annual burden estimates:

Type of Collection	Number of Respondents	Responses per Respondent	Total Responses	Hours per Respondent	Total Burden Hours	Wage Rate	Total Hour Cost
Form A: Feedback Form for Bullying Prevention Training Module Participants	50	1	50	0.25	12.5	$44/hr	$550
Form B: Feedback Form for Bullying Prevention Training Module Participants (follow-up)	50	1	50	0.25	12.5	$44/hr	$550
Form C: Feedback Form for Community Event Participants	300	1	300	0.25	75	$44/hr	$3300
Form D: Feedback Form for Community Event Participants (follow-up)	300	1	300	0.25	75	$44/hr	$3300
Total	350	--	700	--	175	--	$7700

The total burden anticipated through collecting this user feedback is approximately 175 hours, totaling $7700 in total hour cost. All members of the public will have access to the Bullying Prevention Training Module and Community Action Toolkit, and participation in survey activities will not be required in order to use the resources.

Planned frequency of information collection:

This information will be collected in stages: after initial training, four months later, after initial community event using the training resources, and four months later.

13. Estimates of Annualized Cost Burden to Respondents

The only associated cost to respondents is their time to provide the requested information.

14. Estimates of Annualized Cost to the Government

The surveys will be accessible through the StopBullying.gov website. Collection and analysis of the data, including the storage and destruction of personally identifiable information, will be performed by HRSA’s bullying prevention contractor. This activity fits within the existing scope of work and award of this contract with an estimated annual cost of $20,000.

15. Change in Burden

Not Applicable. This is a new activity under HRSA’s generic clearance and will be included in the total burden currently approved by OMB under OMB Control No. 0915-0212.

16. Plans for Analysis and Timetable of Key Activities

All data will be collected by HRSA’s contractor and will occur in the stages outlined previously. The HRSA contractor will compile information from the online survey database and surveys received in Word document format via a secure email account. Personally identifiable information will be destroyed as it is no longer needed for follow up. After 12 months of collection, the contractor will deliver the full data analysis to HRSA. Findings will only be used for internal service improvement and will not be generalized to the public. There are no plans for publication of any survey results.

17. Exemption for Display of Expiration Date

No exemption is being requested. The expiration date will be displayed.

18. Certifications

This information collection activity will comply with the requirements in 5 CFR 1320.9.

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