Supporting Statement

Resources and Services Administration

SUPPORTING STATEMENT

HRSA–Office of Regional Operations – Dallas (ORO–Dallas)

ORO–Dallas State Strategic Partnership Forum Feedback Form

A. Justification

1. Circumstances of Information Collection

The Health Resources and Services Administration (HRSA) currently have approval under the generic clearance, Office of Management and Budget (OMB) Control No. 0915-0212, to conduct customer satisfaction surveys and focus groups. This collection of information helps fulfill the requirements of:

a. Executive Order 12862, “Setting Customer Service Standards,” which directs Agencies to continually reform their management practices and operations to provide service to the public that matches or exceeds the best service available in the private sector.

This is a request for OMB approval of a qualitative voluntary participant satisfaction survey under HRSA’s generic clearance. HRSA’s Office of Regional Operations (ORO)-Dallas will obtain feedback from the participants of ORO-Dallas’ the State Strategic Partnership Forum.

Executive Order 12862 directs agencies that “provide significant services directly to the public” to “survey customers to determine the kind and quality of services they want and their level of satisfaction with existing services”. The objective of surveying the participants is to provide insight on the webinars’ effectiveness and improve future sessions.

2. Purpose and Use of the Information

HRSA is the primary federal agency for improving access to health care by strengthening the health care workforce, building health communities and achieving health equity. ORO-Dallas is one of HRSA’s regional offices whose responsibilities include the following: (1) providing responsive outreach and assistance to HRSA grantees, target populations and stakeholders, (2) partnering with and convene local and regional stakeholders to advance HRSA priorities, (3) representing HRSA at meetings and events to promote HHS/HRSA initiatives, and (4) identifying emerging regional/state trends, priorities, and effective strategies.

The primary use for information gathered through the Dallas State Strategic Partnership Forum feedback form will identify the session’s strengths and weaknesses of the ORO-Dallas sponsored Forum, to determine the level of participants’ satisfaction, and identify areas for improvement.

HRSA/ORO-Dallas will only use the information gathered for internal purposes to obtain a better understanding of how to improve the content of future ORO-Dallas sponsored State Strategic Partnership Forums.

Respondents will include HRSA grantees, public health stakeholders, and healthcare community leaders and professionals. The feedback form includes questions regarding the program’s content, relevancy, and perceptions of the session’s value to improve health service delivery. A copy of the instrument is attached.

3. Use of Improved Information Technology

The feedback form will employ information technology through the use of electronic format attached to Adobe Connect.

4. Efforts to Avoid Duplication

The form is designed to capture specific feedback on the effectiveness of ORO-Dallas sponsored State Strategic Partnership Forum which will be held on October 4, 2016. No other source exists for this information.

5. Involvement of Small Entities

The ORO-Dallas State Strategic Partnership Forum feedback form will not have a significant impact on small businesses or other small entities.

6. Consequences if Information Collected Less Frequently

This information is needed for program improvement for this annual event.

7. Consistency with the Guidelines in 5 CFR 1320.5(d) (2)

The data will be collected in a manner fully consistent with the guidelines in 5 CFR 1320.5(d) (2).

8. Consultation Outside the Agency

The notice required in 5 CFR 1320.8(d) was published in the Federal Register on December 17, 2014, (Vol. 79, No.242, pages 75164). No public comments were received.

The feedback form for this activity was developed by ORO-Dallas staff.

9. Remuneration of Respondents

Not Applicable.

10. Assurance of Confidentiality

Participation is fully voluntary and responses are anonymous. Respondents will be assured that neither their participation/non-participation nor any responses to items will have any effect on their participation in HRSA programs.

11. Questions of a Sensitive Nature

The feedback form does not contain questions of a sensitive nature.

12. Estimates of Annualized Hour Burden

Type of Collection	Number of Respondents	Responses per Respondent	Total Responses	Hours per Respondent	Total Burden Hours
Feedback Form	70	1	70	0.167	11.69
Total	70	--	70	--	11.69

Respondents

Respondents will consist of participants attending or participating in an ORO-Dallas sponsored Forum.

Annual burden estimates

We expect a total of approximately 70 participants to respond to the ORO-Dallas feedback form.

Planned frequency of information collection

This is a one-time project.

13. Estimates of Annualized Cost Burden to Respondents

The only associated cost to respondents is their time to provide the requested information.

14. Estimates of Annualized Cost to the Government

The ORO - Dallas State Strategic Partnership Forum feedback form will be implemented by one ORO staff member. The estimated annual cost to the government is $564.138 which includes an hourly wage for a total of 6 hours from GS-13 annual income ($94,023).

15. Change in Burden

Not Applicable. This is a new activity under HRSA’s generic clearance and will be included in the total burden currently approved by OMB under OMB Control No. 0915-0212.

16. Plans for Analysis and Timetable of Key Activities

The ORO-Dallas State Strategic Partnership Forum feedback form will be administered on October 4, 2016. ORO-Dallas staff will prepare, organize, analyze and consolidate the responses from the ORO-Dallas State Strategic Partnership Forum feedback form. Narrative information from the form will be summarized and examined using descriptive analysis. Findings will only be used internally for program improvement and will not be provided to the public.

17. Exemption for Display of Expiration Date

No exemption is being requested. The expiration date will be displayed.

18. Certifications

This information collection activity will comply with the requirements in 5 CFR 1320.9.