Form PC-2042-B Survey Questions for eNewsletters

Request for Approval under the “Generic Clearance for the Collection of
Routine Customer Feedback” (OMB Control Number: 0420-xxxx)

TITLE OF INFORMATION COLLECTION: Paul D. Coverdell World Wise Schools
Teacher Surveys – E-newsletter

PURPOSE:
The Peace Corps’ Office of Public Engagement promotes the contributions that returned Peace
Corps Volunteers make in the United States after their service. The Office of Public Engagement
comprises Paul D. Coverdell World Wise Schools, the Paul D. Coverdell Fellows Program,
Returned Volunteer Services and the Partnership Unit. The Office of Public Engagement’s
activities and publications support section 2 of the Peace Corps Act, which states that one of the
agency’s missions is to “promote a better understanding of other peoples on the part of the
American people.” 22 USC § 2501. Coverdell World Wise Schools was established in 1989 in
order to bring the cross-cultural experience of Peace Corps Volunteers into the classrooms of the
United States. Within the purview of Coverdell World Wise Schools (CWWS), educators using
CWWS classroom resources who signed up to receive the CWWS monthly e-newsletter are
offered the opportunity to participate in a voluntary survey in order to help CWWS improve the
quality of current online materials and develop new resources based on educator
recommendations.
Survey Details
The Coverdell World Wise Schools teacher surveys are used only by the Coverdell World Wise
Schools office to help improve the quality of current programming and develop new teacher
classroom resources based on teacher suggestions and patterns of use in the classroom.
Who will conduct the survey? Peace Corps’ Coverdell World Wise Schools office staff will
conduct the survey with guidance from Peace Corps’ Office of Strategic Information, Research
and Planning (OSIRP).
Where will we conduct the survey? The surveys will be conducted via an online survey tool
provided by Peace Corps’ Office of Strategic Information, Research and Planning (OSIRP).
When will we conduct the survey? The survey will be conducted beginning in spring 2012 and
continue annually as clearance allows.
DESCRIPTION OF RESPONDENTS:
The survey will be sent (electronically) only to those teachers who have signed up to receive the
Coverdell World Wise Schools electronic newsletter.
TYPE OF COLLECTION: (Check one)
[ ] Customer Comment Card/Complaint Form
[ ] Usability Testing (e.g., Website or Software
[] Focus Group

[X ] Customer Satisfaction Survey
[ ] Small Discussion Group
[ ] Other: ______________________

CERTIFICATION:

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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: Denora Miller, FOIA Officer, Peace Corps.
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, 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 [ X ] No Respondents will not be paid for their participation.
BURDEN HOURS
Category of Respondent

No. of
Participation
Burden
Respondents Time
(hours)
(minutes)
4,500
10
750

Individuals

FEDERAL COST:
Program Analyst (Average starting salary):
$28.00/hour x 30 labor hours/fiscal year = $840.00
Total Labor Costs to the Federal Government: $840.00

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?
[ X] Yes
[] No

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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 customer list comprises those teachers who have signed up to receive the CWWS electronic
newsletter. From that group, no more than 4,500 will be chosen through random sampling, to
receive the survey request via email.

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 - Survey Sheet/Questionnaire
2. Will interviewers or facilitators be used? [ ] Yes [X ] No
How will we conduct the survey?
N/A

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