OMB form Design for Accessibility Survey

Request for Approval under the “Generic Clearance for the Collection of
Routine Customer Feedback” (OMB Control Number: 3135-0130)
TITLE OF INFORMATION COLLECTION: Request to content experts for supplemental
resources, training materials, and recommendations for effective practice on accessibility and
universal design in cultural facilities and libraries.
PURPOSE:
This survey is being administered in the context of a Cooperative Agreement between the
National Endowment for the Arts (NEA) and the Institute for Human Centered Design for the
development and implementation of a comprehensive and interactive Web site, called Design for
Accessibility, that will integrate new and existing cultural accessibility resources.
This survey will share existing databases of Existing Accessibility Guidance and Existing
Training Resources that have been created by the Institute for Human Centered Design ("the
Cooperator") and the NEA project team. Respondents will be asked to review these databases
and share additional suggestions for guidance and training resources and information about
effective practices.
We are turning to a group of the nation’s content experts on accessibility and universal design in
cultural facilities for two reasons:
1. To solicit recommendations for innovative guidance and training materials that can
supplement and enhance our existing pair of databases that will be attached to the survey.
2. To solicit recommendations for effective practices in accessibility and universal design in
cultural facilities and libraries to supplement the existing effective practices in the NEA's
Accessibility Planning and Resource Guide. These include information about programs,
activities, and services that successfully deliver equitable access or enhanced experience to
people with disabilities, including older adults and disabled veterans. In addition to innovative
programming, we seek information on effective or exemplary physical environments,
information technology, communication, and access policies. The survey will request brief
program summaries and other materials that illustrate the reason for recommending it as an
effective practice, as well as contact information for each organization.
DESCRIPTION OF RESPONDENTS:
The survey will be sent to a group of subject matter experts. The group will include the project’s
8-person Task Force of national experts and a set of individuals from a mix of public, non-profit,
and for-profit organizations whose work is centered on issues of accessibility and/or universal
design in cultural facilities and libraries. The respondent list has been assembled by the
Cooperator and the NEA project team.
TYPE OF COLLECTION: (Check one)
[ ] Customer Comment Card/Complaint Form
[ ] Usability Testing (e.g., Website or Software
[ ] Focus Group

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

CERTIFICATION:
I certify the following to be true:
1. The collection is voluntary.

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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:_____ Valerie Fletcher, Executive Director, Institute for Human Centered Design
To assist review, please provide answers to the following question:
Personally Identifiable Information:
1. Is personally identifiable information (PII) collected? [ X ] 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 [X ] No
3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ X ]
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
12
36

Public agencies
Private agencies
Totals

Participation
Time
30 minutes
30 minutes

Burden

24 hours

FEDERAL COST: The estimated annual cost to the Federal government is __$0_
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
[ ] 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 group builds from a core 8-person national task force but also includes leaders who are
known to be innovators (through publication or presentation of their work) in inclusive and

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innovative practices. Twelve public sector leaders come primarily from libraries and State Arts
Councils and the National Park Service. Thirty-six private sector leaders are from a mix of
visual and performing arts organizations nationwide.
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. Design for Accessibility Needs Assessment)
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 required for a respondent to
participate (e.g. fill out a survey or participate in a focus group)

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Burden: Provide the Annual burden hours: Multiply the Number of responses and the
participation time and 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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