Template Justification

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 1800-0011)

TITLE OF INFORMATION COLLECTION: Voluntary Student Engagement Form

PURPOSE: ED’s Office of Communications and Outreach (OCO), to better serve both communications efforts and recognize the voice of constituents served by grant programs, is developing a new tool to solicit information. The Voluntary Student Engagement Form, or V-SEF, would be used to gather data from students with whom Secretary Duncan or other high-level officials interact.

At this time, there is no process or method to solicit information from students who interact with high-level officials in the Department of Education. This lack of process is a barrier to the public better understanding how ED programs and policies are affecting youth and by amplifying the student experiences through various communications and outreach means we can better inform the public. It will also ensure that stakeholders who share their stories will receive a more apt response.

The overall objective of this form and corresponding database would be to collect the personal narrative and contact information of individual students, strengthening the ‘megaphone’ component of our Department by providing a youthful voice to bureaucratic policy operations.

DESCRIPTION OF RESPONDENTS: Surveys will be handed out to participants at the events, with a follow-up to refine responses. Respondents will be students that attend events where Secretary Duncan or other ED officials made appearances.

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: _Engagement form

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 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:__Samuel Ryan _________

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, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ X ] Yes [ ] 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
Youth with whom senior officials have interacted with.	300 (estimated)	30 minutes	150 hours
Totals	300	30 minutes	150 hours

FEDERAL COST: The estimated annual cost to the Federal government is _$3064.50___________

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 [ ] 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?

Administration of the Instrument

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

[ ] Web-based or other forms of Social Media

[ ] Telephone

[X] In-person

[X] Mail

[X] Other, email

2. Will interviewers or facilitators be used? [] Yes [X] No

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