Request for Approval

DI-4011 (Rev. 07/2018)
U.S. Department of the Interior

OMB Control. No. 1090-0011
Expiration Date 10/31/2021

REQUEST FOR APPROVAL UNDER THE
“DOI GENERIC CLEARANCE FOR THE COLLECTION OF
QUANTITATIVE FEEDBACK ON AGENCY SERVICE DELIVERY”

See Page 4 for Instructions on Completing This Form
Title of Information Collection
Artificial Night Lighting – request for published literature or proven best practices for minimizing environmental Impacts associated with artificial night lighting

Purpose
The Bureau of Land Management (BLM) is working with the Argonne National Laboratory (ANL) to develop a library of best management
practices (BMPs) for minimizing environmental impacts from artificial night lighting. Concerns are growing over the environmental impacts
associated with common methods of lighting outdoor spaces at night. Innovative lighting technologies and approaches to spatial lighting
design are emerging that avoid or curtail these impacts. Federal public service will be improved by disseminating an outdoor lighting toolkit
that will enable the target audience to implement effective artificial outdoor lighting BMPs that produce safe outdoor environments and protect
natural night sky conditions.
The toolkit will be a web-based electronic library and a hard-copy publication.
The target audiences that will benefit from the toolkit include:
• Internal BLM programs that administer land use authorizations and oversee the design of public facilities that include outdoor night
lighting elements.
• Industry enterprises with authorized facilities that include outdoor night lighting elements that may affect the public and/ or dark
dependent wildlife habitats.
• Other federal agencies with similar interests and challenges (e.g., National Park Service).
The BLM assembled a network of agencies, organizations, industry enterprises, industry contractors, and universities believed to have
published materials or other forms of information on the subject matter. Respondents will be representatives from within this assembled
network.

Description of Respondents
Respondents will be internal and external.
Internal respondents will include:
• BLM program personnel and other federal agencies that construct and manage facilities that require exterior night lighting or that authorize others to construct and manage these types of facilities on federal public lands (e.g., National Park Service, USDA Forest Service, etc.).
• Other federal agencies with sensitive operations that may be affected by outdoor lighting (e.g., National Oceanic and Atmospheric Administration, National Aeronautics and Space Administration).
Non-federal external respondents will include:
• Non-governmental organizations (e.g., Nature Conservancy, International Dark Sky Association, American Wind Association, International Association of Lighting Designers),
• State and local governments,
• Research universities,
• Industry enterprises (e.g., Southern California Edison, Idaho Power),
• Industry contractors (e.g., lighting design engineers, environmental firms, etc.)
Respondents will be self-selected. Outreach will not require anyone to respond. Those that do respond will be volunteering to provide feedback on published sources of subject matter specific information or examples of proven best management practices.

Type of Collection (Check One)
Customer Comment Card/Complaint Form

Customer Satisfaction Survey

Focus Group

Usability Testing (e.g., Website or Software

Small Discussion Group

Other: Educational Resources

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.
Typed Name of Requester
Signature
Date
John McCarty

Bureau ICCO
Recommend
Not Recommended
DOI PRA Program Lead
Approved
Not Approved

10/24/18

FOR USE BY ICC PROGRAM STAFF ONLY
Signature

DOI Tracking Number
2018-BLM-FT15

Signature

Date

Date

signed by JEFFREY PARRILLO
10/24/18
JEFFREY PARRILLO Digitally
Date: 2018.10.24 08:18:03 -04'00'

Page 1 of 4

DI-4011 (Rev. 07/2018)
U.S. Department of the Interior

OMB Control. No. 1090-0011
Expiration Date 10/31/2021

TO ASSIST REVIEW, PLEASE PROVIDE ANSWERS TO THE FOLLOWING QUESTIONS:
Personally Identifiable Information (Please consult with your Bureau/Office Privacy Act Officer)
1. Will you collect any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)?
No
Yes If “Yes,” please consult with your Bureau/Office Privacy Act Officer.
2. If “Yes”, is the information to be collected included in records that are subject to the Privacy Act of 1974?
No
Yes
3. If applicable, has a System or Records Notice (SORN) been published?
No
Yes If “Yes,” please provide the title and FR citation below:
Title of SORN:
FR Citation for SORN
Gifts or Payments (Please refer to OMB guidance “Questions and Answers When Designing Surveys for Information Collections”)
Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants?
No
Yes If
“Yes”, please describe the incentive and provide a justification for the amount:

Federal Enterprise Architecture (FEA) Business Reference Model (Check only one “Line of Business” and one “Subfunction.”
Refer to OMB guidance “FEA Consolidated Reference Model Document Version 2.3”)
Line of Business
Subfunction
Line of Business
Subfunction
Community and
Social Services
Defense and
National Security
Economic
Development

(Select One)

Correctional
Activities
Disaster
Management

(Select One)

(Select One)

Education

(Select One)

Energy

(Select One)

Environmental
Management

(Select One)

General Science
and Innovation

(Select One)

Health

(Select One)

Homeland Security

(Select One)

(Select One)

(Select One)

Income Security

(Select One)

Intelligence
Operations

(Select One)

(Select One)

Law Enforcement

(Select One)

International Affairs
and Commerce
Litigation and
Judicial Activities

Natural Resources

Conservation, Marine and Land ManagementTransportation

(Select One)

(Select One)

Workforce
(Select One)
Management
Burden Hour Calculation
Category of Respondent

Private Sector

Number of Annual
Respondents

Number of
Responses Each

Total Annual
Responses

Participation
Time

Total Burden
Hours

47

1

47

20 mins

16 hours

Federal Cost: (Consult your Bureau/Office Information Collection Clearance Officer for assistance, if necessary)
The estimated annual cost to the Federal government is $ 2,600.00

, based on: (provide details below)

Outreach to the assembled network of potential responders will result in a significant reduction in BLM’s burden when compared to
the BLM conducting its own internal internet and institutional search for published information.
ANL will catalog the information received from the network of responders. If ANL receives a 100% response of 47 submissions, then
the burden to the BLM is estimated at $2,600 or less. However, a more realistic response would be 50% or less, which would
significantly reduce the burden even further.

Sample Response to Federal Cost Question:
“If we receive 20 submissions and it takes 30 minutes to process and implement each one, then the total burden is $322.40
assuming a GS-7 step 5 is processing the submissions. Please note, however, that this custom form is a tool meant to accept
submissions in a standard format rather than through the freeform submissions that would otherwise come in by personal email.
Thus the existence of this form actually saves the government money by standardizing submissions and decreasing the workload of
processing each one.”
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DI-4011 (Rev. 07/2018)
U.S. Department of the Interior

OMB Control. No. 1090-0011
Expiration Date 10/31/2021

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the
following questions:
Selection of 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?
No
Yes If “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.

Respondents were identified based their associations, research, and known knowledge on night sky and earth science, human
concerns, and exterior night lighting methods affiliated with: human health and safety; security and law enforcement; astronomy;
outdoor recreation experiences; science and education; cultural/ historic values; nocturnal animal habitats.
Spreadsheet with respondent organizations is attached.

Sample Response to Question 1 Above:
“Participants will self-select by choosing to follow the link to submit a resource. This is really no different than any website’s “Contact
Us” type of link; this submission form is only used by those who want to contribute to the toolkit. The “Submit a resource” link will be
located on the bottom of the toolkit homepage.”
Administration of the Instrument:
2.

How will you collect the information? (Check all that apply)
Web-based or other forms of Social Media

Telephone

Mail

Other: Info will be collected through email messages from respondents that
reply to an email message inviting them to volunteer sources of
published info

Use of Interviewers or Facilitators:
3. Will you use interviewers or facilitators?
No

In-person

Yes
PLEASE SUBMIT SURVEY INSTRUMENT, INSTRUCTIONS, AND SCRIPTS WITH YOUR REQUEST.

Page 3 of 4

DI-4011 (Rev. 07/2018)
U.S. Department of the Interior

OMB Control. No. 1090-0011
Expiration Date 10/31/2021

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 and how you will use this information collection. 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, OMB will return the collection as improperly submitted or
they will disapprove your request.
Personally Identifiable Information: Provide answers to the questions.
Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.
Burden Hour Calculation:
•
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. You may select only
one category.
•
No. of Respondents: Provide an estimate of the Number of respondents.
•
Participation Time: Provide an estimate of the amount of time 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 responses and the participation time in minutes and
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:
Selection of 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 you will collect the information. 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.
Submission of the Survey Instrument, Instructions and Scripts: You must submit a copy of the survey instrument, including all
associated instructions and scripts. The survey instrument document must show the OMB Control Number 1090-0011 and Expiration
Date 08/31/2018, along with the following Statements:
Paperwork Reduction Act Statement: We are collecting this information subject to the Paperwork Reduction Act
(44 U.S.C. 3501) to [insert brief justification for collection of information]. Your response is voluntary and we will not
share the results publicly. We may not conduct or sponsor and you are not required to respond to a collection of
information unless it displays a currently valid OMB Control Number. OMB has reviewed and approved this survey
and assigned OMB Control Number 1090-0011, which expires ##/##/####.
Estimated Burden Statement: We estimate the survey will take you ## minutes to complete, including time to read
instructions, gather information, and complete and submit the survey. You may submit comments on any aspect of
this information collection to the Information Collection Clearance Officer, [Insert Bureau], [Insert mailing address].”

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