GMSS Training Evaluation Form

Request for Approval under the “Generic Clearance for the Collection of
Routine Customer Feedback” (OMB Control Number: 2127-0682)
TITLE OF INFORMATION COLLECTION: GMSS Training Evaluation Form
PURPOSE:
The National Highway Traffic Safety Administration (NHTSA), Chief Information Office (CIO) has
invested in a plan to deploy Grants Management Solution Suite into NHTSA's operational
environment. NHTSA will host GMSS training on a voluntary basis so that we may enhance user
experience with utilizing the system. This collection of feedback from the end-user to evaluate their
experience. Voluntary end-user feedback may be used to enhance the GMSS system and training.
The duration of this project is thru August 2019.

DESCRIPTION OF RESPONDENTS:
Public reporting for this collection of information is estimated to be approximately 10 minutes per
response, including the time for reviewing instructions, completing and reviewing the collection of
information. All responses to this collection of information are voluntary. NHTSA would like to receive
comments regarding performance burdens or suggestions for reducing this burden on the end user.

TYPE OF COLLECTION: (Check one)
[X] Customer Satisfaction Survey
[ ] Small Discussion Group
[ ] Other: ______________________

[ ] Customer Comment Card/Complaint Form
[ ] Usability Testing (e.g., Website or Software
[ ] Focus Group
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.
Anitra Collins, GMSS Project Manager & ACOR
Name:________________________________________________
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 N/A
3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No N/A

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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
Participation
Burden
Respondents Time
26
10 mins (ea) 4.3 H

State Government

26

Totals

260 min

4.3h

$0.00
FEDERAL COST: The estimated annual cost to the Federal government is ____________
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 [X] 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?
NHTSA has received significant interest in usability from State Highway Saftey Office (SHSO). Several
SHSO employees volunteer to participate and NHTSA ROPD identifies specific State employees that
agree to participate and provide feedback at their freewill.

Administration of the Instrument
1. How will you collect the information? (Check all that apply)
[x ] Web-based or other forms of Social Media
[x] Telephone (Help Desk Support)
[ ] 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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