Generic Template

1880-0542

Public Burden Statement:

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average five minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is voluntary. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20210-4537 or email [email protected] and reference the OMB Control Number 1880-0542 Note: Please do not return the completed Qualitative Feedback Survey to this address.

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 1880-0542)

TITLE OF INFORMATION COLLECTION: Technical Assistance (TA) Participant Feedback

PURPOSE: This survey is intended to be used at the conclusion of technical assistance (TA) events (e.g., individualized TA, peer-to-peer exchanges, grantee meetings, Community of Practice meetings, or other webinars or convenings) conducted under contracts, grants, or initiatives supported by the U.S. Department of Education (ED). The survey is designed to be appropriate for use to gather participant feedback after either face-to-face or online (i.e., virtual) TA interactions. The closed-ended and open-ended items are designed to elicit responses about the quality, relevance, and effectiveness of TA services. Results of this survey will be used by project teams to facilitate continuous improvement and future programming decisions, and also used by project teams and ED staff for evaluation purposes.

This TA feedback survey can be used as part of a broader evaluation plan sponsored by ED’s Office of Elementary and Secondary Education. Specifically, this TA feedback survey can be used in conjunction with end-of-year surveys and semi-structured interviews, direct observation of TA events to assess quality of materials and delivery, web-usage logs for on-line resources, and other forms of data collection. OMB clearance for these other data collection components will be sought as applicable.

DESCRIPTION OF RESPONDENTS: Respondents will be individuals, representatives of State and Local educational agencies and other organizations supporting the operation and improvement of education in the United States, who have participated in one or more TA events conducted as a part of a contract or initiative supported by ED. Participants in individualized TA, peer-to-peer exchanges, or Communities of Practice facilitated by the State Support Network, sponsored by ED’s Office of State Support, would be examples of such respondents. All respondents will be adults, responding to the survey as a part of their professional roles.

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: Christopher Tate, (202)453-6665

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

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Individuals	7,466	5 minutes	622 hours
Totals	7,466	5 minutes	622 hours

FEDERAL COST: The estimated annual cost to the Federal government is $0.00

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

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?

ED will know the complete list of participants in TA events based on event registration with registrants being comprised of grantees and others supporting the implementation of ED administered grants. All participants will be asked to complete this voluntary survey (thus, a census rather than a sample will be our goal).

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

[X] In-person

[ ] Mail

[ ] Other, Explain

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

As a part of an online administration, the facilitator or coordinator of a webinar or conference call will alert TA participants of the request that they complete a survey, and will instruct participants on how to access and submit the survey. As a part of an in-person administration, a TA facilitator or coordinator will distribute the paper-and-pencil survey and explain its purposes.

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