Fast Track Clearance Request - USDA Foods Household Fact Sheets Feedback Survey

Request for Approval under the “Fast Track Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0584-0611)

TITLE OF INFORMATION COLLECTION: USDA Foods Household Fact Sheets Feedback Survey

PURPOSE: The USDA Food and Nutrition Service, Food Distribution Division maintains a database of fact sheets, describing foods available to our household food programs. These programs include the Food Distribution Program on Indian Reservations (FDPIR), the Commodity Supplemental Food Program (CSFP), and The Emergency Food Assistance Program (TEFAP). The fact sheets include basic product descriptions, food storage and preparation information, nutrition information, and example recipes. We are preparing to update these fact sheets to ensure that they provide the information most needed by our stakeholders. The purpose of this survey is to learn more about how our stakeholders currently use the fact sheets, the types of information they find most valuable, and any additional information they may require.

DESCRIPTION OF RESPONDENTS: The survey will be distributed to our Regional Offices, who will then forward the survey to Indian Tribal Organizations (ITOs) that participate in FDPIR as well as States that participate in CSFP and TEFAP. In addition, States will be requested to forward the survey to local agencies that administer CSFP and TEFAP to participants. We will also request the assistance of the National CSFP Association (NCSFPA) and Feeding America in reaching these local agencies. The email announcing the survey will contain a link to the survey in Wufoo, which respondents can fill out and submit at their convenience. Participation in the survey is voluntary.

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: Sam Hunley

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

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No

Sensitive Information:

1. Will sensitive information, such as demographic characteristics, be collected from respondents?

[ ] Yes [X] No

2. If yes, explain the necessity of such information to the programmatic objective(s)?

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, Local, and Tribal Governments (respondents)	1,054	20 minutes (0.334)	352.04
State, Local, and Tribal Governments (non-respondents)	2,108	3 minutes (0.0501)	105.61
Totals	3,162	23 minutes	457.65

FEDERAL COST: The estimated annual cost to the Federal government is $819.56

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

2. 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?

The survey will be distributed to our Regional Offices, who will then forward the survey to Indian Tribal Organizations (ITOs) that participate in FDPIR as well as States that participate in CSFP and TEFAP. The survey will then be forwarded to local CSFP and TEFAP agencies by States as well as partner organizations, including NCSFPA and Feeding America. There are 54 CSFP and TEFAP agencies, each of which are, on average, staffed by 3-5 personnel, resulting in an estimated 216 personnel. There are approximately 1,777 CSFP and TEFAP local agencies, and we assume that the survey will reach 1-2 personnel at each agency, resulting in an estimated 2,666 personnel. Finally, there are 112 ITOs who administer FDPIR, and we assume that the survey will reach 3-5 personnel at each ITO, resulting in an estimated 280 personnel. In total, we estimate that the survey will be received by 3,162 individuals. Participation in the survey is completely voluntary. We estimate that we will achieve a 30% response rate such that 1,054 individuals will complete the survey, and 2,108 will read the email but choose to not participate in the survey.

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

Please make sure that all instruments, instructions, and scripts are submitted with the request.

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.

SENSITIVE INFORMATION: If you answer yes to the question, please describe the nature of the sensitive information being collected (e.g., race, sexual behavior or attitudes, religious beliefs, and other matters that are commonly considered private) and provide a justification for its use.

BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households; (2) Businesses (i.e., Profit, Not for Profit, and/or Farms); (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.

6