Template for Submitting Activities Under the Clearance

Key Elements for OMB Memos under the Generic Clearance

for Data User Evaluation Surveys 0607-0760

[Title of the Study]

The Census Bureau plans to conduct additional survey work under the generic clearance for Data User Evaluation Surveys (OMB number 0607-0760).

Purpose of the Study

The Census Bureau’s [Division] ([Branch]) is planning a survey to.....[reason for survey]. The feedback from this survey will help the Census Bureau decide [what?](ex. next steps for this program).

Is this a new survey or has this survey been conducted before? If it has been used before, explain how the information was used and if there is a report available of those results.

The key research questions or substantive issues being examined are:

• A

• B

• C

Survey Methodology

What is the sampling frame and it’s source?

What is the design of the sample and how will respondents be selected (or is it a census of everyone in the frame)?

Provide details on the administration of the survey, including the mode(s), number of contacts,

how you plan to notify/solicit participation of respondents to the survey and include copies of these materials as attachments].

Respondents

What is the size of the universe and the size of your sample for this survey?

What is the expected response rate and resulting sample size?

Burden

[Division] staff have reviewed and internally tested the questionnaire for ease of use and content appropriateness. [note: If the survey was conducted previously, but there are some new items that were not asked previously, please identify these.

Specific techniques and pretesting methods that we used were [explain in detail].

We estimate respondent burden at [??] minutes per questionnaire for a total respondent burden of [??] hours.

Incentives

[Incentives are not used with customer surveys. Incentives may be used for cognitive interviews and focus groups. The standard amounts for these activities are: $40 cognitive interviews; $75 focus groups. Any proposal to provide incentives higher than these amounts requires a strong justification as to why the target group necessitates higher incentives.

Attachments/Enclosures

[List and describe all attachments and enclosures (solicitation emails, reminders, thank you email, etc.)]

We plan to maximize response rates by including [personalized letters, reminder post cards, a second mailing of questionnaires, and follow up telephone calls, etc.].

For further information about this study, please contact [Name] at [Telephone Number] or [Email Address].