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

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

TITLE OF INFORMATION COLLECTION: Customer satisfaction survey for soliciting feedback on technical assistance (TA) provided to NAL@ED grantees

PURPOSE: This survey will assess the effectiveness of the TA provided to five NAL@ED grantees from fall to summer 2018. The TA focused on helping grantees prepare to implement their grant activities and included the following topics: goals, objectives, and outcomes, staffing, budget, partnerships, curriculum and assessments, and continuous improvement. The goal of this survey is to understand which topics and delivery methods grantees found most beneficial, as well as solicit feedback on additional topics that they would find valuable. The results of this survey will inform TA plans for next year.

DESCRIPTION OF RESPONDENTS: The respondents will be the five NAL@ED grantees: Anchorage School District, Lac Courte Oreilles Band of Lake Superior Chippewa Indians, Oglala Lakota College, San Carlos Apache Tribe, and Yukon-Koyukuk School District. Only the 40 staff members who have participated in the TA activities will be asked to complete the survey.

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:__Angela Hernandez-Marshall

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
(3) State, local, or tribal governments	40	7 minutes	4.67 hours
Totals	40	7 minutes	4.67 hours

FEDERAL COST: The estimated annual cost to the Federal government is $18348.10_____

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?

Potential respondents will include all team members from Native American Language grant projects who participated in technical assistance activities delivered by the Office of Indian Education’s contracted staff.

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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