Request for Approval

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-1009)

TITLE OF INFORMATION COLLECTION: VetoViolence Online Survey

PURPOSE:

VetoViolence is a comprehensive online source for professionals working in the field of violence prevention. Professionals can utilize various tools and trainings across violence types, including: child maltreatment, intimate partner violence, sexual violence, suicide, and youth violence. Through these resources, professionals are able to enhance their own local violence prevention efforts.

The purpose of this survey is to obtain additional information on user satisfaction with the online tools and trainings. The information collected will be used to improve the content and functionality of the website and develop supplemental resources to help users learn more skills for their violence prevention work.

DESCRIPTION OF RESPONDENTS:

VetoViolence is designed primarily for violence prevention practitioners, but anyone working to prevent violence in their communities will find the information useful. Respondents will primarily include individuals that use the VetoViolence training, tools, and resources. Audience targeting shows us that users primarily include—but aren’t limited to—CDC partners, grantees, researchers, program evaluators, technical assistance providers, and decision-makers. VetoViolence can also be used by the media, policymakers, and the general public.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ X] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [ ] Other: ______________________

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:____________Karen Angel____________________________________

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

3. If Applicable, has a System or Records Notice 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
Online Survey with web page users	500	10 minutes	83
Totals	500	10 minutes	83

FEDERAL COST: The estimated annual cost to the Federal government is ____$300.00___

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?

A link to the online survey will be placed on the VetoViolence homepage. It will be highlighted in a call out box that says “Help Us Improve the VetoViolence Website”. Users can then decide to voluntarily complete the online survey. Links to the survey tool will also be shared through the VetoViolence Facebook page.

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

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