Focus Group Participant Feedback Survey for HHS Region II Pilot Curriculum

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0990-0379)

TITLE OF INFORMATION COLLECTION:

Focus Group Participant Feedback Survey for HHS Region II Pilot Curriculum on Human Trafficking Awareness and Response

PURPOSE:

The US Department of Health and Human Services (HHS) Region II Office of the Assistant Secretary for Health and Administration for Children and Families are preparing to launch a training curriculum on human trafficking awareness and response entitled “SOAR - S-Stop,

O-Observe, A-Ask, and R-Respond: Building Capacity, Collaboration and Coordination of Services for Survivors of Human Trafficking.” The curriculum supports Goal 1 and 3 of the Federal Strategic Action Plan on Services for Victims of Human Trafficking in the United States, 2013-2017:

• Goal 1: Align Efforts: promote a strategic, coordinated approach to the provision of services for victims of human trafficking at the federal, regional, state, territorial, tribal, and local levels.

• Goal 3: Expand Access to Services: provide and promote outreach, training and technical assistance to increase victim identification and expand the availability of services.

The one-day pilot curriculum aims to provide federal leadership to identify vulnerable children, youth, women, and men at risk for human trafficking, promote effective, culturally appropriate, trauma-informed services that improve the short- and long-term health, safety, and well-being of trafficked persons, and foster collaborations to enhance the regional response to human trafficking. The pilot curriculum is regional in scope, covering the four HHS Region II jurisdictions of New Jersey, New York, Puerto Rico, and the US Virgin Islands.

Four focus group sessions will be convened to pilot the course curriculum in each of the four HHS Region II jurisdictions: one focus group session in New Jersey, one in New York, one in Puerto Rico, and one in the US Virgin Islands. The purpose of the focus group session is to pilot the course curriculum and collect comments and ratings from participants on it through the Focus Group Participant Feedback Survey. Feedback will allow HHS Region II to understand the strengths and weaknesses of the pilot curriculum and to improve the pilot curriculum to best meet future training needs.

DESCRIPTION OF RESPONDENTS:

Respondents will be focus group participants, comprised of staff from federal, state, territorial government agencies, community-based organizations and other stakeholder groups based in New Jersey, New York, Puerto Rico, and US Virgin Islands working in anti-trafficking, health, social services, child welfare, domestic violence and sexual violence prevention, legal, law enforcement, academia, and related fields.

TYPE OF COLLECTION: (Check one)

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

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[x] 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: __Sandra Bennett-Pagan, LCSW, Regional Women’s Health Coordinator, HHS Region II OASH Office on Women’s Health

Michelle S Davis, PhD, Regional Health Administrator, HHS Region II OASH__________

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 [ ] 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
State and Territorial Government	24	2/60	0.8
Private Sector: Community-based Organization	24	2/60	0.8
Totals	48		1.6 hr

FEDERAL COST: The estimated annual cost to the Federal government is $2,000.00__________

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? [ ] 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?

Focus group attendees will serve as Participant Feedback Survey respondents. Project Officers will compile a list of potential focus group invitees with input from the Project Work Group, comprised of subject matter experts and service providers working in anti-trafficking from the fields of law enforcement, legal services, violence prevention, health and social services. The following criteria will be used for selection of focus group invitees:

• Experts on human trafficking prevention or intervention

• Federal government agency representatives currently serving trafficking persons, e.g., HHS, DOJ, FBI, ICE, HS, etc.

• State or territorial government representatives with programs for children, youth, women, or men at risk for human trafficking

• Community-based organizations representatives serving trafficked persons or those at risk for human trafficking

• Services provided in one of the four jurisdictions of HHS Region II: New Jersey, New York, Puerto Rico, US Virgin Islands.

Administration of the Instrument

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

[ ] Web-based or other forms of Social Media

[ ] Telephone

[x] 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.

Focus Group Participant Feedback Survey is attached.

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

TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the subject of the request. (e.g. Comment card for soliciting feedback on xxxx)

PURPOSE: Provide a brief description of the purpose of this collection and how it will be used. If this is part of a larger study or effort, please include this in your explanation.

DESCRIPTION OF RESPONDENTS: Provide a brief description of the targeted group or groups for this collection of information. These groups must have experience with the program.

TYPE OF COLLECTION: Check one box. If you are requesting approval of other instruments under the generic, you must complete a form for each instrument.

CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.

Personally Identifiable Information: Provide answers to the questions. Note: Agencies should only collect PII to the extent necessary, and they should only retain PII for the period of time that is necessary to achieve a specific objective.

Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.

BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households ;( 2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be selected per row.

No. of Respondents: Provide an estimate of the Number of respondents.

Participation Time: Provide an estimate of the amount of time required for a respondent to participate (e.g. fill out a survey or participate in a focus group)

Burden: Provide the Annual burden hours: Multiply the Number of responses and the participation time and divide by 60.

FEDERAL COST: Provide an estimate of the annual cost to the Federal government.

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. Please provide a description of how you plan to identify your potential group of respondents and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.

Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.

Submit all instruments, instructions, and scripts are submitted with the request.

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