Respectful Workplaces survey short form

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 3046-0048)

TITLE OF INFORMATION COLLECTION:

Respectful Workplaces Training Customer Feedback Survey

PURPOSE:

EEOC has a statutory mandate under Title VII of the Civil Rights Act of 1964 to provide technical assistance and training on the laws it enforces, see 42 U.S.C. §2000e-4(j), and offers training programs through the EEOC Training Institute to keep the public informed of the latest developments in equal employment opportunity law. These training and technical assistance seminars are vital to eliminating unlawful discrimination in the workplace, and to ensure that the programs are effective, EEOC needs feedback from participants. One such training is a newly developed seminar on Respectful Workplaces. This training will focus on respect, acceptable workplace conduct, and the types of behaviors that contribute to a respectful and inclusive organizational culture, including sections on the concept of respect, the spectrum of workplace behaviors (including respectful, uncivil, abusive, and illegal behaviors), employer policies and procedures, fairness, bystander intervention, effective coaching, and how to provide and receive feedback. The training is intended for any workplace that would like to examine appropriate workplace conduct, and has separate modules for supervisors and non-supervisory employees. Participants will be asked to complete a survey before and after the training. The pre- and post-training format of the survey will help EEOC gauge the success of the training by illustrating whether the attendees’ awareness and understanding of the subject matter has increased by the end of the program.

DESCRIPTION OF RESPONDENTS:

Participants in respectful workplaces programs. Attendance is voluntary – participating workplaces request the training from EEOC.

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: Pre- and post-training customer attitude survey to assess effectiveness of program

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:_____Erin Norris___________________________________________

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	AnnualBurden
(2) – Respectful Workplaces Training Attendees Pre-training survey	3000	10 minutes per response	500 hours
(2) – Respectful Workplaces Training Attendees Post-training survey	3000	10 minutes per response	500 hours
Totals	3000		1000 hours

FEDERAL COST: The estimated annual cost to the Federal government is ____$6050_______

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? [ ]Yes [x] 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?

All participants in the courses will be asked to respond to a pre-training and post-training survey.

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.

Instructions for completing Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”

TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the subject of the request. (e.g. Comment card for soliciting feedback on xxxx)

PURPOSE: Provide a brief description of the purpose of this collection and how it will be used. If this is part of a larger study or effort, please include this in your explanation.

DESCRIPTION OF RESPONDENTS: Provide a brief description of the targeted group or groups for this collection of information. These groups must have experience with the program.

TYPE OF COLLECTION: Check one box. If you are requesting approval of other instruments under the generic, you must complete a form for each instrument.

CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.

Personally Identifiable Information: Provide answers to the questions. Note: Agencies should only collect PII to the extent necessary, and they should only retain PII for the period of time that is necessary to achieve a specific objective.

Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.

BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households; (2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be selected per row.

No. of Respondents: Provide an estimate of the Number of Respondents.

Participation Time: Provide an estimate of the amount of time (in minutes) required for a respondent to participate (e.g. fill out a survey or participate in a focus group)

Burden: Provide the Annual burden hours: Multiply the Number of Respondents and the Participation Time then divide by 60.

FEDERAL COST: Provide an estimate of the annual cost to the Federal government.

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. Please provide a description of how you plan to identify your potential group of respondents and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.

Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.

Submit all instruments, instructions, and scripts are submitted with the request.

5