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:

Arid Lands Initiative Community Forum Questionnaire

PURPOSE:

The Arid Lands Initiative (ALI) is a partnership of State, Federal, and NGO entities that work to implement a shared conservation vision for the Columbia Plateau based on sustaining healthy landscapes and native species, and maintaining or improving connections between habitat areas, while maintaining and improving local communities and their economies.

The ALI would like to use the questionnaire results to plan and execute a public meeting of specific land owners within our Yakima Training Center-Hanford project area that we are collectively working on improving ecological conditions within. The relevant issues of wildfire preparedness, response and restoration are believed to be topics of common interest between ALI partners and the local landowners and state, federal and tribal stakeholders. ALI would like to use the questionnaire responses to inform our initial discussions with local landowners and possibly find common areas of landscape conservation concern to further our work in the area.

DESCRIPTION OF RESPONDENTS:

We are soliciting information from these stakeholders within our project area:

15 private landowners

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  Other: _questionnaire______

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: /s/ Jessica Gonzales

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

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? Yes 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

3. If Applicable, has a System or Records Notice been published? Yes  No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? Yes  No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Private landowners	15	10 mins	2.5 hrs

FEDERAL COST: The estimated annual cost to the Federal government is $674 (rounded).

If we receive 15 submissions and it takes 20 minutes to process each one (5 hrs total), then the processing burden is approximately $371 (rounded), using GS-13 labor ($74.10/hr Cost to Govt). Data will be compiled on a spreadsheet that will take 4 hours to create, costing $296 (rounded). Postage is $7 (rounded), if we have to mail the questionnaires. Therefore the total cost is equal to $674 (rounded)

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  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.

We have selected 15 participants from a list of landowners and lessees that comprise the major land holders in the Hanford-YTC landscape.

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

Other, Explain

2. Will interviewers or facilitators be used? Yes  No

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