Generic Template

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

TITLE OF INFORMATION COLLECTION: SEA Needs Assessment- Title IV, Part A

PURPOSE: The National Center on Safe Supportive Learning Environments (NCSSLE) is working collaboratively with the Office of Safe and Healthy Students (OSHS) to effectively build a foundation of resources and technical assistance to support the Every Student Succeeds Act, Title IV, Part A (Title IV-A), Student Support and Academic Enrichment (SSAE) grant program’s grantees, including state educational agencies (SEAs), sub-grantees, local educational agencies (LEAs), and schools. This foundation will allow SEAs, LEAs, and schools to build their capacity to provide all students with access to a well-rounded education, improve school conditions for student learning, and improve the use of technology to support academic achievement and digital literacy of all students, while leveraging the SSAE funds to tailor their resources based on the needs of their unique student populations.

Preliminary steps in the process are to assess the needs of SEAs related to Title IV, Part A SSAE program support and implementation and to inform the development of a set of resources, training materials and technical assistance support.

DESCRIPTION OF RESPONDENTS: SEA Title IV, Part A 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

[ X] 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: Bronwyn Roberts, Director, Title IV, Part A TA Center

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ X] Yes [ ] 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	52	60 minutes	52 hours
Totals	52	60 minutes	52 hours

FEDERAL COST: The estimated annual cost to the Federal government is $30,000.

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?

A list of the 52 Title IV, Part A state coordinators will be provided by the OSHS/ED.

Administration of the Instrument

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

[ ] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ X ] Other, Explain Video Web Conference

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

Please make sure that all instruments, instructions, and scripts are submitted with the request.

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