Opportunity Youth Bundling Pilot Submission Template

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

TITLE OF INFORMATION COLLECTION: Opportunity Youth Evaluation Bundling Instrument Pilot

PURPOSE: The Opportunity Youth Evaluation Bundling project is an effort to build evidence and evaluation capacity in some of CNCS’ smaller AmeriCorps State and National Grantees. Main data collection proposes to survey 640 total opportunity youth (treatment and comparison individuals). The purpose of this request is to pilot test an evaluation instrument and related data collection procedures to be used in the Opportunity Youth Evaluation Bundling project (currently posted for 60 day public comment). Specifically, we will administer the survey instrument in the three modes intended for main data collection (by phone, online, and in person) to a sample sufficiently large enough to conduct psychometric testing. Cognitive interviewing and free response questions in the pilot survey will generate valuable qualitative data that can be used to refine survey instructions, question wording, and user experience. It will also check construct validity. Psychometric testing, made possible by a larger sample size, will provide quantitative insight into the survey’s validity, allowing further refinement and streamlining of the instrument. Random assignment of participants to one of the three modes (paper, online, phone) will allow us to isolate mode effects from potential confounders and examine whether mode has an effect on response rates and the nature of response to particular items. Pilot testing will also help refine expected response rates, alerting us to any potential challenges that should be addressed before main data collection. Finally, extensive pilot work prior to main data collection will ensure that the funds invested in the project will generate a valuable survey instrument that can be repeatedly administered into the future.

DESCRIPTION OF RESPONDENTS: We will survey 75 current AmeriCorps State and National members who are currently participating in programs selected as participants in the Opportunity Youth Evaluation Bundling project. These respondents are between the ages of 16 and 24, and are enrolled in an AmeriCorps program at least part-time. Most are unemployed, lack post-secondary education (many lack a GED or high school diploma), and are disconnected from their communities.

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: _Survey pilot test __

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:__Adrienne DiTommaso______________________________________________

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 [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
AmeriCorps members	75	15 min. each	18.75 hrs.
Totals			18.75 hrs.

FEDERAL COST: The estimated annual cost to the Federal government is: this is a one-time research project and will not incur additional annual costs.

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?

Grantee participants in the evaluation (9 AmeriCorps State and National programs) will randomly select pilot participants from their lists of their current members to provide 8 names and contact information of respondents to the project’s contractor. In some cases, the 8 selected will be the entire universe of respondents available for a grantee due to small program size; in others, the 8 will be a small portion of a grantee’s total membership.

The pilot will test the three modes of administration intended for main data collection: via phone, online, and in-person. The project’s contractor will use the list of names submitted by the participating grantees to randomly assign participants to a survey mode. The CNCS project manager will receive aggregated results of the survey and will not see individual responses or contact information.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[X] Web-based or other forms of Social Media

[X] Telephone

[X] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [X] Yes [ ] 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 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 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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