RSA Webinar Participant Feedback Survey Generic Template

RequestApproval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 1880-0542)

T ITLE OF INFORMATION COLLECTION: RSA National Clearinghouse of Rehabilitation Training Materials (NCRTM) Webinar Participant Feedback

PURPOSE:

The purpose of the information collection is to evaluate the success of the webinar from the participant perspective (program content usefulness and quality; ease of use) and to use the results for continuous improvement.

DESCRIPTION OF RESPONDENTS:

Respondents will vary depending on the topic of the webinar. Broadly, respondents will include representatives of entities interested in applying for RSA Training grants; current RSA grantees; state vocational rehabilitation staff; rehabilitation educators; service providers and researchers.

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:__Kristen Rhinehart-Fernandez______________________________________________

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 [ X] No

3. If Applicable, has a System or Records Notice 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	Participation Time	Burden
Private Sector (13 webinars per year @70 participants per webinar)	910	5 minutes	76 hours
State, local or tribal governments (12 webinars per year @70 participants per webinar)	840		70 hours
Totals	1750	5 minutes	146 hours

FEDERAL COST: The estimated annual cost to the Federal government is $1000.00.

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? [ 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?

Registered webinar participants will be surveyed. All registered participants will be invited respond, therefore, there is no sampling plan.

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