Fast Track Submission Short Form_Cultural Responsiveness Webinar

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0970-0401)

T ITLE OF INFORMATION COLLECTION: Feedback from participants at the Enhancing the Cultural Responsiveness of Social Services Webinar.

PURPOSE:

The ACF Office of Planning, Research and Evaluation (OPRE) is seeking approval to collect feedback from Enhancing the Cultural Responsiveness of Social Services webinar participants. The webinar seeks to:

1. expand ACF staff and grantees’ understanding of what it means to be culturally responsive/competent;

2. facilitate discussion about potential strategies that ACF programs can adopt to advance cultural responsiveness;

3. explore ways to assess and evaluate cultural responsiveness within ACF programs; and

4. foster a culture of learning and reflection about diversity within ACF programs.

We will collect information through a registration form, a feedback form, and two polls during the presentation.

The registration form will provide information about who attends the webinar. Specifically, this form will collect information about participants’ professional roles, level of education, their familiarity with the content matter of the webinar presentation, and their reason for participating. This information will enable us to more effectively tailor the content of the remaining webinars in the series to the needs and interests of our audience. Facilitators will use the polls to adapt content during the presentation. The feedback form is intended to capture participants’ experiences, gauge their satisfaction with the webinar presentation, and determine what other topics would be of interest to this group. Findings will be used internally by OPRE to improve the planning of future meetings/webinars to meet the needs of our stakeholders.

DESCRIPTION OF RESPONDENTS:

The webinar forms will be provided to all meeting participants, which we expect to include grantees, researchers, and federal program staff.

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:_ Ann Rivera, Social Science Research Analyst, ACF Office of Planning, Research and Evaluation____________

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, 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
Individuals – Registration Form	100	5 minutes	8 hours
Individuals - Feedback Form	100	10 minutes	17 hours
Individuals – Poll	100	5 minutes	8 hours
Totals			33 hours

FEDERAL COST: The estimated annual cost to the Federal government is __$100______

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?

OPRE will distribute all proposed information collections to the full list of webinar attendees.

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

Please make sure that all instruments, instructions, and scripts are submitted with the request.

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