Office of Adolescent Health Individual Technical Assistance Survey

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0990-0379)

TITLE OF INFORMATION COLLECTION:

Office of Adolescent Health Individual Technical Assistance Grantee Satisfaction Survey

PURPOSE:

The Office of Adolescent Health (OAH) at the U.S. Department of Health and Human Services (HHS) requests permission to conduct an assessments of grantees’ satisfaction with the in-depth, individual-level technical support that OAH offers to a subset of its funded grantees. The episodic surveys will assess specific OAH-sponsored technical assistance (TA) activities provided by OAH staff and OAH contractors to individual grantees. Results of these surveys will provide OAH with ongoing information that may be used to improve the quality of future grantee support.

DESCRIPTION OF RESPONDENTS:

OAH funds Teen Pregnancy Prevention (TPP) grantees and Pregnancy Assistance Fund (PAF) grantees. The contractor will contact Teen Pregnancy Prevention (TPP) grantee and Pregnancy Assistance Fund (PAF) grantee program directors who work on their cooperative agreements. The universe of organizations to be contacted includes Fiscal Year 2015 TPP Grantees and FY 2018 TPP and PAF Grantees.

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: ___Tara Rice_____________________________________________

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
Private Sector (Web survey or conference paper survey) – Individual TA surveys	15	3/60	1 hour
Totals	15	3/60	1 hour

FEDERAL COST: The estimated annual cost to the Federal government is $2,000.

For cost calculations, we estimate 5 hours of time for a GS-14. These hours account for OAH staff to create and distribute the surveys, and then collect and review customer feedback. For the contractor, we estimate 10 hours of an intermediate staff member’s time to program the surveys and tabulate the results and 2 hours of senior staff time to review the results.

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?

Description of Customer List. OAH’s list of project directors for the grantee organizations that participate in the individual-level technical assistance events will be used as the customer list. The grant programs, listed by category, are displayed in the Table 1 below.

Sampling Plan. The universe of potential respondents will include all of the project directors on the grantee list for PAF and TPP grantees who participate in individual-level technical assistance events.

There is a survey that would be administered to grantees after individual technical assistance events. We estimate 15 individual technical assistance events for OAH grantees. Therefore, we will have up to 15 respondents for the individual technical assistance surveys.

Table 1. Number of grantees to which survey will be distributed by program and tier within the TPP program

OAH Grant Program/Tier	N	Tier Count (n)
Pregnancy Assistance Fund (PAF)	23
Teen Pregnancy Prevention (TPP) – total number	91
TPP by FY and tier:
FY15
Tier 1A – Capacity Building for Evidence-based Programs; pass-through with sub-awardees; implementation of evidence-based TPP; replication		7
Tier 1B – Implementing Evidence-based Programs to Scale; emphasis on implementation of programs and evaluation, with some sub-awardees; communities with greatest need		47
Tier 2A – Early Innovation (pass through with sub-awardees; programs and evaluation; innovative strategies; early innovation)		2
Tier 2B – Rigorous Evaluation of New Approaches ; innovative strategies; implementation of programs and evaluation; rigorous evaluation of new or innovative approaches		21
FY18
Tier 2 Phase 1 – New and Innovative Strategies		14
TOTAL	114	91

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.

5