FastTrack Generic Submission Form - PMFO-UCLA NDMP Feedback Surveys

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0970-0401)

TITLE OF INFORMATION COLLECTION: New Director Mentor Program (NDMP) Feedback Surveys

PURPOSE:

The New Director Mentor Program Feedback surveys collect information at four different points in time from new Head Start directors participating in the Program Management and Fiscal Operations (PMFO)-University of California, Los Angeles (UCLA) Head Start New Director Mentor Program (NDMP). The program includes a three-day intensive training institute and participant engagement in a year-long, one-on-one interactive relationship with a mentor.

The initial feedback survey is administered to participants immediately after completion of the three-day intensive training institute. During the year, three additional check-in surveys are administered to get feedback on this mentoring component of the program: one survey is administered after 3 months (NDMP Feedback Survey – 90 Day Check-In), another survey is offered after approximately 8 months (NDMP Feedback Survey – Two-Thirds Check-In), and the final survey is offered at the end of the year-long mentoring component (NDMP Feedback Survey – Final Check-In).

These satisfaction surveys provide timely feedback to program managers in an efficient manner to improve future service delivery, specifically to improve the future delivery of the NDMP.

DESCRIPTION OF RESPONDENTS:

Respondents include participants in the New Director Mentor Program, all of whom are new Head Start directors.

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: David Jones, Senior Program Specialist/Federal Program Officer, Office of Head Start

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

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

The burden for the four feedback surveys are the following: 7 minutes for the initial survey, 5 minutes for the first follow-up, 3 minutes for the second follow-up, and 5 minutes for the final survey. The burden per respondent is 20 minutes. The total burden hours are below:

Category of Respondent	No. of Respondents	Participation Time	Burden
New Head Start Directors	63	20 minutes	21 hours
Totals	63	20 minutes	21 hours

FEDERAL COST: The estimated annual cost to the Federal government for all four surveys is $1,302.

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?

The list of participants are individuals that participate in a three-day intensive training at UCLA and the year-long mentoring component that follows. The evaluation team will administer the first survey in-person at the training and the periodic check-in surveys will be emailed and completed in a web-based format.

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

[X] 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 with the request.