National Adoption Month

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0980-0266)

T ITLE OF INFORMATION COLLECTION: 2014 National Adoption Month Customer Satisfaction Assessment

PURPOSE: Each November during National Adoption Month, a Presidential Proclamation launches activities and celebrations to help build awareness of adoption throughout the nation. Thousands of community organizations arrange and host programs, events, and activities to share positive adoption stories, challenge the myths, and draw attention to the thousands of children in foster care who are waiting for permanent families. Child Welfare Information Gateway hosts the National Adoption Month Website that targets adoption professionals by focusing on ways to use social media to build States' capacity to recruit and retain parents for the 104,000 children and youth in foster care waiting for adoptive families.

This is a request for approval by the Office of Management and Budget (OMB), under the Federal Paperwork Reduction Act of 1995, for a new data collection task to be added to the Administration for Children and Families’ already approved generic OMB clearance # 0980-0266. The proposed information collection activity includes delivering a voluntary and anonymous online satisfaction survey and one polling question to users accessing the National Adoption Month (NAM) website.

Data collected from the proposed survey and polling question will be used to better understand who uses the NAM website and what suggestions they have for NAM website enhancements. This information, in turn, will be used by the Children’s Bureau to better meet the needs of professionals using the NAM website.

DESCRIPTION OF RESPONDENTS: Respondents will include State and local governments, the territories, service providers, Indian Tribes and tribal organizations, grantees, researchers, and significant other service providers serving target populations identified by and funded directly or indirectly by ACF. An estimate of the annual response burden is outline in the following table.

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 [X] Other: Customer Satisfaction Assessment

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 [X] No

2. If Yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [X] 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 [X] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
State, local, or tribal governments	100	0.05035	5.035
Private sector	100	0.05035	5.035
Federal Government	100	0.05035	5.035
Individuals or households	100	0.05035	5.035
Totals	400*	-	20.14

*This table includes the burden estimates for both the NAM website survey and the NAM polling question. We expect to obtain 200 responses for each of these data collection methods for a total of 400 annual respondents.

FEDERAL COST: The estimated annual cost to the Federal government is approximately_$3,500.00__

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?

National Adoption Month Online Survey. The figures outlined in the burden table above are based on an estimate of approximately five minutes to respond and submit each online survey. The respondent sample size (200) is based on our experiences conducting surveys of similar size and scope including a survey that was used on the National Adoption Month website during 2013. A survey “widget” will be used on each page of the National Adoption Month website that when clicked will hyperlink to an online version of the survey. An email blast will also be sent to adoption stakeholders asking them to provide feedback by taking the online survey.

National Adoption Month Online Polling Question. The figures outlined in the burden table above are based on an estimate of approximately one minute to respond and submit each polling question. The respondent sample size (200) is based on our experience using a polling question on the National Adoption Month website during 2013. We plan to ask one polling question on the homepage of the National Adoption Month website during 2014. Last year we collected 161 responses using the polling question and this year we expect to increase our annual National Adoption Month website visits and collect 200 responses to the polling question.

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

[ ] In-person

[ ] Mail

[ ] Other, Explain

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

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

Instructions for completing Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”

TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the subject of the request. (e.g. Comment card for soliciting feedback on xxxx)

PURPOSE: Provide a brief description of the purpose of this collection and how it will be used. If this is part of a larger study or effort, please include this in your explanation.

DESCRIPTION OF RESPONDENTS: Provide a brief description of the targeted group or groups for this collection of information. These groups must have experience with the program.

TYPE OF COLLECTION: Check one box. If you are requesting approval of other instruments under the generic, you must complete a form for each instrument.

CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.

Personally Identifiable Information: Provide answers to the questions. Note: Agencies should only collect PII to the extent necessary, and they should only retain PII for the period of time that is necessary to achieve a specific objective.

Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.

BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households; (2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be selected per row.

No. of Respondents: Provide an estimate of the Number of Respondents.

Participation Time: Provide an estimate of the amount of time (in minutes) required for a respondent to participate (e.g. fill out a survey or participate in a focus group)

Burden: Provide the Annual burden hours: Multiply the Number of Respondents and the Participation Time then divide by 60.

FEDERAL COST: Provide an estimate of the annual cost to the Federal government.

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. Please provide a description of how you plan to identify your potential group of respondents and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.

Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.

Submit all instruments, instructions, and scripts are submitted with the request.

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