Fast Track Clearance Form Toolkit

OMB Control No: 0970-0401

Expiration date: 5/31/2018

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”

TITLE OF INFORMATION COLLECTION:

AFI Capacity Building Toolkit Usability Test

PURPOSE:

The U.S. Department of Health and Human Services (HHS) Administration for Children and Families (ACF) Office of Community Services (OCS) has contracted with the Corporation for Enterprise Development (CFED) to perform capacity building services for Assets for Independence (AFI) Program grantees. Through this contract, CFED is developing a toolkit to help grantees design more responsive AFI projects. CFED will deploy a usability test to obtain feedback on draft sections of the toolkit.

DESCRIPTION OF RESPONDENTS:

The respondents will be Assets for Independence grantee staff that volunteer for the usability test while in attendance at an AFI grantee meeting on Sept. 27 in DC or while in attendance at the CFED Assets Learning Conference on Sept. 28.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[X] 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: Gretchen Lehman

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 [ ] No [X ] Not applicable

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No [X] Not applicable

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	Estimated Number of Respondents	Estimated Participation Time	Estimated Burden
AFI grantee staff	16	.5 hours	8 hours
Totals	16	.5	8

FEDERAL COST: The estimated annual cost to the Federal government is $750.00_

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?

Some staff from AFI grantees will be attending the 2016 CFED Assets Learning Conference in Washington DC Sept. 28-30, 2016. OCS is holding a meeting in DC for AFI grantees that want to attend on the day before the conference, Sept.27. At this meeting, we will make an announcement to grantees about the usability testing opportunity, as follows:

“We are soliciting feedback from AFI grantees around a planned toolkit. This toolkit aims to help grantees use participant input to design responsive services. We’d love to have some volunteers test it out to help us improve its effectiveness. To volunteer for this Toolkit feedback, please sign up.”

We have a sign-up sheet with 16 slots available (attached). If all of those slots are not all filled at the grantee meeting, this sign-up sheet will be posted at a booth during the first day of the Assets Learning Conference (Sept. 28) along with the attached sign.

Individuals that sign-up will be given a flier with information about where and when they will be conducting the usability testing. A sample of this flier is attached.

Administration of the Instrument

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

[ ] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[X] Other, Explain

Combination – there will be a facilitator that sets up each respondent with a hard copy of the draft toolkit section to review and a computer on which they complete the survey (attached) online using Survey Monkey. After they have completed the survey, the facilitator will thank them for their feedback and ask "Is there anything else you'd like to share about using this toolkit?"

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

Please submit all instruments, instructions, correspondences (emails, letters, etc.) to respondents, and scripts as separate documents along with this request document.