OCAT Submission Template

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number 3045-0137)

TITLE OF INFORMATION COLLECTION:

CNCS Organizational Capacity Assessment Tool

PURPOSE: The Corporation for National and Community Service (CNCS) worked with ICF to develop a reliable and validated organizational capacity assessment tool tailored for CNCS grantees. The purpose of this tool is to enable CNCS grantees to identify strengths and areas for potential capacity building, and to measure changes in organizational capacity over time.

DESCRIPTION OF RESPONDENTS:

Respondents will include active funded organizations of the Corporation for National and Community Service and other organizations that choose to participate. The respondent will be the designated organization point of contact as listed on the funded organization's application.

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: Organization Capacity Assessment

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: Greg Wallinger_____________________________

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, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Yes, has an up-to-date System of Records Notice (SORN) 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
OCAT User	100	30 minutes	300 minutes
Totals	100	30 minutes	300 minutes

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:

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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