Generic Template

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 1800-0011)

TITLE OF INFORMATION COLLECTION: National Survey of SEAs- Title 1, Part D State Coordinators

PURPOSE: The National Technical Assistance Center for the Education of Neglected or Delinquent Children and Youth (NDTAC) collaborating with the Office of Safe and Healthy Students (OSHS) will conduct a national survey in order to effectively provide resources, technical assistance and capacity building activities to support the Elementary and Secondary Schools Act, Every Student Succeeds Act, Title 1, Part D (TIPD) program, (Prevention and Intervention Programs for the Education of Children and Youth Who Are Neglected, Delinquent or At-Risk).At the Federal level of government, the TIPD program provides direct assistance to States receiving Title 1, Part D funds, schools, communities, and parents seeking information on the education of children and youth who are considered neglected, delinquent, or at-risk.

NDTAC will conduct an electronic survey of all State Educational Agencies (SEA’s) (specifically each state’s Neglected and Delinquent Coordinator) that receive Part D, Subpart 1 funds to gather reliable information on the programs operated by each State since the administration of juvenile justice and education varies widely across States. This information will help assess the needs of SEAs related to Title 1, Part D program support and implementation and to inform the development of a set of resources, training materials and technical assistance support. This survey is designed to inform the USDOE about key responsibilities of coordinators, what are the typical expenditures of funds on supports and services and other findings that may impact outcomes in future years.

DESCRIPTION OF RESPONDENTS: SEA Title I, Part D Coordinators or their designee.

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 [X] Other: Survey (electronically)

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: Simon Gonsoulin, Director, National Technical Assistance Center for the Education of Neglected or Delinquent Children and Youth

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 [ 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	52	30 minutes	26
Totals	52	30 minutes	26

FEDERAL COST: The estimated annual cost to the Federal government is $11,090

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 survey is strictly designed for the State Neglected and Delinquent Coordinator at each SEA. The coordinators administer the TIPD programs for each state. We will survey all 52 state coordinators.

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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