3170-0024 IC Template MSOA

Request for Approval under the “Generic Clearance for the Collection of
Qualitative Feedback on the Service Delivery of the Consumer Financial
Protection Bureau” (OMB Control Number: 3170-0024)

TITLE OF INFORMATION COLLECTION: Money Smart for Older Adults Train-the-Trainer
Session Feedback Form and Money Smart for Older Adults Participant Evaluation Form.

PURPOSE: To assess how trainers view the effectiveness of the Money Smart for Older Adults
(MSOA) train-the-trainer curriculum and to survey how MSOA session participants view the
effectiveness of the training curriculum. With respect to the train-the-trainer curriculum, feedback is
particularly being sought on: the clarity of the information presented; the instructor’s comfort level
with teaching the curriculum; how the curriculum will be used; if the instructor’s would recommend
the curriculum to other potential instructors; and how many older adult participants they expect to
reach with the curriculum.

DESCRIPTION OF RESPONDENTS: For the MSOA Train-the-Trainer Session Feedback Form
respondents will include individuals representing adult social service agencies, law enforcement,
financial services, legal professionals and retired professionals from diverse backgrounds who have
participated in a Money Smart for Older Adults train-the-trainer program online or in a face-to-face
session. For the Participant Evaluation Form respondents will include older adults aged 62+, family
caregivers, senior advocates and financial service representatives who have received the presentation
of the Money Smart for Older Adults consumer training program.
TYPE OF COLLECTION: (Check one)
[ ] Customer Comment Card/Complaint Form
[ ] Usability Testing (e.g., Website or Software
[ ] Focus Group

[X ] Customer Satisfaction Survey
[ ] Small Discussion Group
[ ] Other:

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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
Information Collection

Number of
Participation
Respondents
Time
1,000
2 minutes
5,000
5 minutes
6,000 ////////////////////////

Train-the-Trainer Session Feedback Form
Participant Evaluation Form
Totals

FEDERAL COST: The estimated annual cost to the Federal government is $0.

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Burden
Hours
33
416
449

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
2.

[ ] No [ ] N/A

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?
For the Train-the-Trainer Session Feedback Form the universe of potential respondents
will be taken from the list of participants in the MSOA Train-the-Trainer program. For the
Participant Evaluation Form the list of potential respondents will be taken from the list of
participants in the MSOA curriculum.

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
[x] Mail
[ ] Other, Explain
2. Will interviewers or facilitators be used? [ ] Yes [x] No

CERTIFICATION:
By submitting this document, the Bureau certifies the following to be true:
 The collection is voluntary.
 The collection is low-burden for respondents and low-cost for the Federal Government.
 The collection is non-controversial and does not raise issues of concern to other federal
agencies.
 The results are not intended to be disseminated to the public.
 Information gathered will not be used for the purpose of substantially informing influential
policy decisions.
 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.
 The results will not be used to measure regulatory compliance or for program
evaluation.

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