request for Approval

Request for Approval under the “DOI Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery”

OMB Control Number: 1090-0011

TITLE OF INFORMATION COLLECTION: Partner Assessments for the Urban Wildlife Conservation Program and Urban Bird Treaty Cities

PURPOSE:

This partner assessment is a tool for Service staff to use with Urban Wildlife Conservation Program partners and Urban Bird Treaty City partners. The purpose is for individual refuge field stations, urban refuge partnerships, and Urban Bird Treaty City partnerships to assess what is going well and what could be improved in the relationship with partners. This information will help improve work with partners, address any concerns, build trust, and increase understanding of shared goals and commitment to reaching them.

DESCRIPTION OF RESPONDENTS:

Respondents are individuals representing themselves or a group, organization, or institution who participates in or support activities, projects, or program being implemented on urban wildlife refuges, in urban refuge partnerships, or by an Urban Bird Treaty City.

TYPE OF COLLECTION: (Check one)

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

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

[ ] Focus Group [x] Other: _partnership assessment_

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: Danielle Ross-Winslow

To assist review, please provide answers to the following questions:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [x] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No [x] NA (not collecting PII)

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ ] No [x] NA (not collecting PII)

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [x] No (If yes, please explain.)

BURDEN HOURS

Multiply the Number of responses and the participation time in minutes and divide by 60.

Category of Respondents	No. of Respondents	Participation Time	Burden
Individuals and/or private sector	150	30 min	75 hours
Totals	150	30 min	75 hours

FEDERAL COST: The estimated annual cost to the Federal Government to administer this information collection is $30,830.

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.

There is not a master list that defines the universe of potential respondents. Individual refuges, urban refuge partnerships, and Urban Bird Treaty Cities keep track of their partners and will use the assessment as desired with partners to assess how well the relationship is working. There is no sampling plan.

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 – the assessment will be emailed as a .pdf form to potential respondents. They will complete the form and return it via email.

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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