Fast Track request form

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0420-0545)

TITLE OF INFORMATION COLLECTION: Survey of 2016-17 Peace Corps Campus Ambassador students

PURPOSE: The purpose of the information collection is to analyze the user experience of a key stakeholder group of the Peace Corps Campus Ambassador program – the students themselves. This information collection will inform business decisions that the Peace Corps makes regarding next year’s program.

DESCRIPTION OF RESPONDENTS: All respondents will be members of the public who have opted into to promoting Peace Corps on their university or college campuses for the 2016-17 academic year. These individuals are students who actively liaise with the Peace Corps.

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:_ Denora Miller, FOIA/PA Officer

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

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
Survey (1) Individuals or Households	470	5 minutes	39
Totals	470	5 minutes	39

FEDERAL COST: The estimated annual cost to the Federal government is $102.10

• 16-Day Cost For Third Party Survey-Tool Used to Conduct Survey: $43.84

• Peace Corps Staff Annual Hourly Estimate to Process/Analyze Survey Results: 2 hours

• Annual Labor Cost for Survey Processing/Analysis by Peace Corps Program Specialist: $ 58.26

  • ($60,794 annual salary of a Program Specialist/2087 hrs = $29.13 per hour)

  • ($29.13 hourly wage of a Program Specialist * 2 hrs = $58.26)

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

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 information collection will involve one short online survey of 470 students promoting Peace Corps on their colleges and universities as part of the Campus Ambassadors program. These 470 students are the entire universe of potential respondents.

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.

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