Generic Clearance Request

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 2127-0682)

T ITLE OF INFORMATION COLLECTION:

PURPOSE:

The United States Department of Transportation’s (USDOT), Departmental Office of Civil Rights (DOCR) and Office of Small and Disadvantaged Business Utilization (OSDBU) seek to conduct a customer satisfaction survey concerning the October 26, 2016 DBE Summit – “Access to Opportunity for the DBE/Small Business Community.” The survey will be voluntary and confidential and will provide the Department with useful feedback to help evaluate the successfulness of the event. The survey will also help the Department to organize, plan, and conduct future DBE/small business technical assistance and networking events.

DESCRIPTION OF RESPONDENTS:

Respondents are individuals who attended the DBE Summit. The attendees consisted of private business firms, transportation associations, state Recipients, and federal employees who work within the DBE Program.

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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: Lakwame Anyane-Yeboa

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
Individuals	*320	1	.25 hrs
Totals

FEDERAL COST: The estimated annual cost to the Federal government is 80

Approximately 60 federal government employees attended the DBE Summit as moderators, presenters, and to receive training on DBE related issues (e.g., Certification, Title VI enforcement, and issues related to Alaska Native Corporations). We have adjusted the federal to exclude the 60 respondents who are federal employees. Accordingly, federal is derived from 320 respondents (380 total respondents less 60 respondents who are federal employees).

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?

DOCR and OSDBU created a badge list for those individuals who sent an RSVP for the event (please see attached list). The survey questions will go out to respondents who submitted an RSVP for the event.

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

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