Generic Clearence Submission Form

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

T ITLE OF INFORMATION COLLECTION:

SAVER PROGRAM PROJECT TOPIC SURVEY

PURPOSE:

The purpose of this information collection activity is to solicit suggestions from the first responder community on possible topics for future projects conducted by the Systems Assessment and Validation for Emergency Responders (SAVER) program. SAVER

produces knowledge products providing operationally-relevant equipment information that allows first responder organizations to identify, acquire, use and maintain the equipment that is best suited to their personnel.

DESCRIPTION OF RESPONDENTS:

Members of the two groups identified below are the targeted respondents.

First Responders Resources Group (FRRG). The FRRG is an all-volunteer working group that advises the DHS Science and Technology Directorate (S&T) on the needs of first responders in the field. It is comprised of 120 active and retired first responders from a broad range of disciplines (law enforcement, fire service, emergency medical service, emergency management, etc.) from local, state, tribal, and federal government organizations from all regions of the United States.

The InterAgency Board (IAB). The IAB is a voluntary working group of 200 state, local, and federal first responders from the fire, law enforcement, and medical/health organizations throughout the United States. IAB members investigate and prioritize research and development opportunities for first responder equipment, technology, standards, training, and strategic planning and produce topic-specific white papers regarding emergency response issues.

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: _Web-based survey__

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:___John Kada_____________________________________________

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

Type of Respondent(s)	Form Name/ Form Number	No. of Respondents	No. of Responses per Respondent	Avg. Burden per Response1 (hours)	Total Annual Burden (hours)	Avg. Hourly Wage Rate2 (Dollars per hour)	Total Annual Respondent ($)
Firefighters		69	1	0.15	10.35	34.96	361.82
Firefighter 1st Line Supervisors		65	1	0.15	9.75	53.47	521.29
Police Officers		89	1	0.15	13.35	43.44	579.95
Police 1st Line Supervisors		13	1	0.15	1.95	61.64	120.20
Emergency Medical Techs.		45	1	0.15	6.75	24.70	166.70
Emergency Management Dir.		34	1	0.15	5.10	54.61	278.53
TOTAL:		315			47.25		2028.49

Notes:

1) The SAVER Project Survey will be an online questionnaire created on, and hosted by, the Survey Monkey website. The Survey Monkey website provides an estimate of the completion time of each questionnaire crested on its website. For the SAVER Project Topic questionnaire, Survey Monkey estimates that the questionnaire will take 0.15 hours (9 minutes) to complete, including reading the instructions embedded in the questionnaire. Respondents do not need to gather any kind of information to complete the questionnaire, thus 0.15 hours is the average burden per response.

2) Based on the mean hourly wage rates in the May 2017 National Occupational Employment and Wage Estimates for the United States obtained from the Bureau of Labor Statistics (BLS) website (https://www.bls.gov/bls/blswage.htm).

• For firefighters (BLS occupation code 33-2011) the mean hourly wage is $24.97; with a 1.4 benefits multiplier this is $34.96.

• For firefighter supervisors (BLS occupation code 33-1021) the mean hourly wage is $38.19; with a 1.4 benefits multiplier this is $53.47.

• For police officers (BLS occupation code 33-3050) the mean hourly wage is $31.03; with a 1.4 benefits multiplier this is $43.44.

• For police officer supervisors (BLS occupation code 33-3050) the mean hourly wage is $44.03; with a 1.4 benefits multiplier this is $61.64.

• For emergency medical technicians (BLS occupation code 29-2041) the mean hourly wage is $17.64; with a 1.4 benefits multiplier this is $24.70.

FEDERAL COST: The estimated annual cost to the Federal government is:

The estimated annual cost to the federal government in relation to this information collection is $ 3,264.

The estimated annualized cost to the Federal government for this collection is calculated to be approximately $ 3,264. The following method was used to estimate the cost (based on General Schedule Grade 13, step 06, 2019 NEW YORK-NEWARK-BRIDGEPORT, NY-NJ-CT-PA locality, fully loaded annual pay of $ 163,215 ($ 116,582 x 1.4 benefit multiplier = $ 163,215)):

• Cost of the Federal Employee to review web-based survey_form: 1 person x 2% of annual time = $ 3,264

Annualized Cost Analysis:

a. Printing cost: $ 0

b. Collecting and processing $ 3,264

c. Total cost to program: $ 3,264

d. Fee charge: $ 0

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?

Both FRRG and IAB are relatively small organizations, therefore there is no need to selectively sample their memberships. All members of both organizations will be invited to participate in the survey. Invitations to participate in the survey will be sent to the leadership of each organization who will then share these invitations with their members, stressing that the survey is voluntary in nature.

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.

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