Fast-Track Template

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0503-0021)

TITLE OF INFORMATION COLLECTION: Acreage Crop Reporting Streamlining Initiative (ACRSI) Pilot Participant Survey

PURPOSE: Survey producers participating in the Farm Service Agency (FSA) channel of ACRSI pilot to see if goals were reached from the producers prospective. The survey results will be used as part of the pilot success analysis, lessons learned, and next phase preparation.

DESCRIPTION OF RESPONDENTS: Current FSA Producer Pilot Participants – Producers from 15 counties in Iowa and 15 counties in Illinois.

	State	County			State	County
	Illinois	Bureau			Iowa	Benton
	Illinois	Christian			Iowa	Boone
	Illinois	DeWitt			Iowa	Calhoun
	Illinois	Iroquois			Iowa	Humboldt
	Illinois	LaSalle			Iowa	Iowa
	Illinois	Livingston			Iowa	Jasper
	Illinois	Logan			Iowa	Johnson
	Illinois	McLean			Iowa	Keokuk
	Illinois	Macon			Iowa	Linn
	Illinois	Marshall			Iowa	Madison
	Illinois	Moultrie			Iowa	Marshall
	Illinois	Piatt			Iowa	Poweshiek
	Illinois	Putnam			Iowa	Sac
	Illinois	Sangamon			Iowa	Warren
	Illinois	Stark			Iowa	Wright

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: Todd Anderson, Section Head, Common Process Section, Program Deliver Branch, PECD.

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 [ x ] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ x ] 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
Individuals or Households	200	5 min	16.5 hrs
Totals

FEDERAL COST: The estimated annual cost to the Federal government is $1,000.

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?

FSA producers have been identified for participation in the ACRSI pilot. The universe of respondents is known.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ x ] Web-based or other forms of Social Media (Survey Monkey)

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [ x ] No

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