Justification of Submission

DI-4010 (Rev. 07/2018)
U.S. Department of the Interior

OMB Control. No. 1040-0001
Expiration Date 10/31/2021

JUSTIFICATION FOR SUBMISSION UNDER THE
“DOI PROGRAMMATIC CLEARANCE FOR
CUSTOMER SATISFACTION SURVEYS”

See Page 5 for Instructions on Completing This Form
1. Bureau/Office

2. Date Submitted

US Fish and Wildlife Service

10/16/2018

3. Survey Title
Improving the Partners for Fish and Wildlife Program to Ensure Longevity of Voluntary Conservation Efforts

4. Abstract (Not to exceed 150 words)
The Partners for Fish and Wildlife (Partners) Program of the U.S. Fish and Wildlife Service (Service) delivers fish and wildlife
conservation by supporting voluntary habitat restoration through financial and technical assistance to private landowners. To better
meet the needs of private landowners, a mailed survey will be sent to past participants in the Partners Program. The survey will follow
Dillman’s (2014) “Tailored Design Method” and will obtain information on the following from past participants:
•
•
•
•
•

satisfaction with the Partners Program
retention of conservation practices
conservation behavior as a result of Partners Program participation
factors that encourage participants to work with the Partners Program
how participants’ involvement in the Partners Program relates to continued environmental stewardship.

5. Bureau/Office Point-of-Contact Information
First Name

Last Name

Brad

Milley

Title

Bureau/Office

Social Scientist

Human Dimensions Branch, Natural Resource Program Center

Mailing Address

City

1201 Oakridge Dr., Ste. 320

Fort Collins

Phone
(970) 266-2998

■

Work
Cell

Fax

State
CO

Zip Code
80525

Email
[email protected]

6. Principal Investigation (PI) Point-of-Contact Information
First Name
Jerry

Last Name
Vaske

Title
Professor

Bureau/Office
Dept. of Human Dimensions of Natural Resources, CSU

Mailing Address
1480 Campus Delivery

City
Fort Collins

Phone
(970) 491-2360

Work
Cell

Fax
(970) 491-2255

State
CO

Zip Code
80523-1480

Email
[email protected]
Page 1 of 6

DI-4010 (Rev. 07/2018)
U.S. Department of the Interior

OMB Control. No. 1040-0001
Expiration Date 10/31/2021

7. Name of Program or Office Conducting Survey
Colorado State University

8. Description of Customers and Services Provided

Past participants in the Partners program

9. Survey Dates
(mm/dd/yyyy)

01/04/2018

(mm/dd/yyyy)
01/31/2019

to

10. Type of Information Collection Instrument (Check ALL that Apply)
Intercept

Telephone

Mail

Web-based

Comment Cards

Other: (Explain)
Focus Groups
11. Survey Development (Who assisted in survey content development statistics? Was the survey pretested? How did you
integrate improvements? Which of the six topic areas did you address?)
Who assisted in survey content development statistics? U.S. Fish and Wildlife Service and Colorado State University
Was the survey pretested? Yes
How were improvements integrated? Suggested revisions were incorporated into the survey
Which of the six topic areas will be addressed?) #1-Delivery, quality and value of products, information and services; #2-Management practices;
#3-Mission management; and #6-General demographics

12. Survey Methodology (Use as much space as needed; if necessary, include additional explanation on separate page.)
12A. Respondent Universe

There were 450 past participants in the Partners Program who conducted either riparian, upland, or wetland
projects between 2001 and 2006 in the US Fish and Wildlife Service’s Northwest and Southwest Regions.
12B. Sampling Plan/Procedure
Contact 450 landowners who participated with Partners Program in US Fish and Wildlife Service Northwest and Southwest Regions between 2001 and
2007 and who conducted either riparian, upland, or wetland projects. Contacts will be made by mail with telephone follow-up to nonrespondents.
The sample will be stratified by region and habitat type.

12C. Instrument Administration

Surveys will be mailed to past participants in the Partners Program. The survey will follow Dillman’s (2014) “Tailored
Design Method” and include a pre-notice letter, mail survey, reminder postcard, and second mail survey.
12D. Expected Response Rate and Confidence Levels

60% +/- 5%
12E. Strategies for dealing with potential non-response bias

Telephone follow-up calls to non-respondents
12F. Description of any pre-testing and peer review of the methods and/or instrument (recommended)
The survey was pretested using 9 former participants in the Partners program.
The survey was peer reviewed by colleagues in the Human Dimensions of Natural Resources Department at Colorado State University.

13. Burden Hours Calculations
Category of Respondent

Number of Annual
Respondents

Number of
Responses Each

Total Annual
Responses

Time per
Response

Total Burden
Hours

Initial Contact

450

1

450

2 min

15

Completion of Survey Instrument

270

1

270

18 min

81

Totals: 720

720

96

Page 2 of 6

DI-4010 (Rev. 07/2018)
U.S. Department of the Interior

OMB Control. No. 1040-0001
Expiration Date 10/31/2021

14. 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

Workforce
Management
15. Reporting Plan

(Select One)

(Select One)

(Select One)

Survey results will be provided to the core team of the study via a peer-reviewed project report. Subsequent publications
will include peer reviewed journal articles and presentations. A copy of all survey reports will be provided to PPA.
16. Justification, Purpose, and Use
16A. Survey Justification and Purpose

The survey is necessary to gauge the effectiveness of the Partners program in meeting customers’
needs.
16B. Survey Goals

To better understand the strengths and weaknesses of the Partners program in order to improve
collaborative work with private landowners for conservation outcomes.
16C. Utility to Managers

Will help managers improve the Partners programs and better serve future participants in the
program.
16D. How will the results of the survey be analyzed and used?

Data will compare and contrast different regions of the country to determine if region specific
adjustments to the Partners program are needed.
16E. How will the data be tabulated? How What Statistical Techniques will be used to generalize the results to the entire
customer population? How will limitations on use of data be handled? If the survey results in a lower than anticipated
response rate, how will you address this when reporting the results? (Use as much space as needed; if necessary, include
additional explanation on separate page.)

See next page
16F. Is this survey intended to measure a Government Performance and Results Act (GPRA) performance measure? If
yes, please include an excerpt from the appropriate document. (Use as much space as needed; if necessary, include additional
explanation on separate page.)

NA

Page 3 of 6

How will the data be tabulated?
The data will be analyzed using SPSS (i.e., Statistical Package for the Social Sciences)
What Statistical Techniques will be used to generalize the results to the entire customer population?
The statistical test will depend on the level of measurement (i.e., dichotomous, categorical, continuous). In general, however, we will
use the following statistical techniques:
Crosstabulations / Chi-square
Analysis of Variance / F-value
Potential for Conflict Index (Vaske, Beaman, Barreto, & Shelby, 2010)
- The Potential for Conflict Index (PCI) was developed to facilitate understanding and applicability of human
dimensions findings to managerial concerns. PCI ranges from 0 (minimal) to 1 (maximum) potential for conflict and
simultaneously describes a variable’s central tendency, dispersion & shape using a graphic display.
How will limitations on use of data be handled? If the survey results in a lower than anticipated response rate, how will you
address this when reporting the results? (Use as much space as needed; if necessary include additional explanation on separate
page).
If the response rate is lower than anticipated, the data will be weighted using the formulas in Vaske (2008, pp. 212-216).
 In the event of a low response rate the disparity in results between mail survey and nonresponse check, it may be prudent
to weight the data from the mail survey, as follow:
 Weight = (population %) / (Sample %)
o For example, disparity in male/female ratio
 Weight males = 0.60 / .30 = 2.0 Weight females = 0.40 / 0.70 = 0.57

DI-4010 (Rev. 07/2018)
U.S. Department of the Interior

OMB Control. No. 1040-0001
Expiration Date 10/31/2021

17. Federal Cost: (Consult your Bureau/Office Information Collection Clearance Officer for assistance, if necessary)
The estimated annual cost to the Federal government is $ 96,607.60

, based on: (provide details below)

The contracted cost for this project is $95,078. An additional 40 hours for a GS-12 step 1 at $38.24 an hour totals $1,529.60. The
estimated annual cost to the Federal government is $96,607.6.
Sample Response:
“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. 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. The existence of this form actually
saves the government money by standardizing submissions and decreasing the workload of processing each one.”
18. The survey methodology presented in form DI-4010 includes a specific description of:
■ The respondent universe,
■ The sampling plan and all sampling procedures, including how respondents will be selected,
■ How the instrument will be administered,
■ Expected response rate and confidence levels,
■ Strategies for dealing with potential non-response bias,
■ A description of any pre-testing and peer review of the methods and/or the instrument is highly recommended,
■ The burden hours reported in the Justification include the number of burden hours associated with the initial contact of all
individuals in the sample (i.e., including refusals), if applicable, and the number of burden hours associated with individuals
expected to complete the survey instrument, and
■ The package is properly formatted (using MS Word) and submitted to the Office of Policy Analysis (through the Bureau/Office
Information Collection Clearance Officer).
19. The approval package includes:
■ A completed and signed Form DI-4010, Generic Clearance for Customer Satisfaction Surveys.
■ A copy of the survey instrument.
■ Other supporting materials, such as:
• Cover letters to accompany mail-back questionnaires,
• Introductory scripts for initial contact of respondents,
• Necessary Paperwork Reduction Act and Estimated Burden compliance language, and/or
• Follow-up letters/reminders sent to respondents.
20. Checklist for Submitting a Request to Use DOI Programmatic Clearance for Customer Satisfaction Surveys
■ All questions in the survey instrument are within the scope of one of the DOI Programmatic Clearance for Customer
Satisfaction Surveys topic areas.
■ A qualified statistician has reviewed and approved your request (see question 21A).
■ Your Bureau/Office Information Collection Clearance Officer receives your package for review/approval at least 75 days
prior to the first day the PI wishes to administer the survey to the public.
21. Required Certifications for Submission Under OMB Control Number 1040-0001
Certification is required to submit a collection of information for approval under the DOI Programmatic Clearance for Customer
Satisfaction Surveys. If the collection does not satisfy the requirements of the Programmatic Clearance, you should follow the
regular PRA clearance procedures described in 5 CFR 1320.
21A. Bureau/Office Statistician
Signature
Date
Recommend

Not Recommended

KATIE LYON (Affiliate)

21B. Bureau/Office Program or Subgroup

Bureau/Office Point-of-Contact

Human Dimensions Program

Brad Milley

Title (Please be specific)

Digitally signed by KATIE LYON (Affiliate)
Date: 2018.10.16 12:16:58 +10'00'

10/16/18

Digitally signed by BRAD MILLEY
Date: 2018.10.16 14:41:45 -06'00'

10/16/18

Signature

BRAD MILLEY

Social Scientist

Date

FOR PROGRAM USE ONLY
Required certifications: The information collection requested by this submission meets the requirements of OMB Control No. 1040-0001

Bureau/Office ICCO
Recommend

Signature
Not Recommended

DOI Office of Policy Analysis
Recommend

10/16/18

Signature

Date

Signature

Date

Not Recommended

DOI PRA Program Lead
Approved

MADONNA BAUCUM

Date
Digitally signed by MADONNA BAUCUM
Date: 2018.10.16 17:23:35 -04'00'

DOI Tracking No.

Not Approved

Page 4 of 6

DI-4010 (Rev. 07/2018)
U.S. Department of the Interior

OMB Control. No. 1040-0001
Expiration Date 10/31/2021

Instructions for Completing Form DI-4010,
Justification for Submission Under the
“DOI Programmatic Clearance for Customer Satisfaction Surveys”
OMB Control Number 1040-0001
1.

Bureau/Office: Insert the name of the bureau/office conducting the survey.

2.

Date Submitted: Date you submit the package to the Bureau/Office Information Collection Clearance Officer (ICCO) for review.

3.

Survey Title: Insert title for the proposed survey.

4.

Abstract: Summarize the proposed study with an abstract not to exceed 150 words.

5.

Bureau/Office Point of Contact Information: Complete the bureau/office contact information. PPA will communicate with the
point of contact listed here throughout the entire approval process.

6.

Principal Investigator (PI) Conducting the Survey: Complete information about the PI who will be conducting the survey, if
different from Point of Contact listed in #4. Otherwise note: Same as #4.

7.

Name of Program Office Conducting Survey: Provide the name of the bureau program, office, or organizational unit conducting
the survey.

8.

Description of Customers and Services Provided: Provide a brief description of the customers you will survey, the services
provided by the program conducting the survey, and customers receive these services.

9.

Survey Dates: List the time-period in which you will conduct the survey, including specific starting and ending dates. The starting
date should be at least 75 days after the date you submit the package to your bureau/office Information Collection Clearance
Officer (ICCO).

10. Type of Information Collection Instrument: Check the type(s) of information collection instrument(s) you will use. If other,
please explain.
11. Survey Development: Explain how the survey was developed. With whom did you consult during the development of the survey
on content? On statistics? Did you pretest the survey? What actions did you take to improve the survey? What suggestions did
you receive for improving the survey? Which of the six topic areas will the collection address? (Note: A description of any pretesting and peer review of the methods and/or instrument is highly recommended.)
12. Survey Methodology: Explain how you will conduct the survey. Provide a description of the survey methodology including:
•
Question 12A – The respondent universe,
•
Question 12B – The sampling plan and all sampling procedures;
•
Question 12C – How the instrument will be administered;
•
Question 12D – Expected response rate and confidence levels;
•
Question 12E – Strategies for dealing with potential non-response bias; and,
•
Question 12A – Description of any pre-testing and peer review of the methods and/or instrument (recommended, but not
required).
Note: Web-based surveys are not an acceptable method of sampling a broad population. Web-based surveys must be limited to
services provided by the web site.
13. Burden Hours Calculations: Provide an estimated total of the following for each category – initial contact and completion of
survey instrument:
•
Number of annual respondents – Enter the number of unique respondents who will complete the information collection;
•
Number of responses per respondent – Enter the total number of responses per unique respondent;
•
Total annual responses – Enter the number of unique respondents multiplied by the total number of responses each;
•
Time per response – Estimate the time to complete the initial contact and the time to complete the survey instrument (in
minutes), and
•
Total burden hours –The total burden hours should account for the amount of time required to instruct the respondents in
completing the survey, and the amount of time required for the respondent to complete the survey.
14. Federal Enterprise Architecture (FEA) Business Reference Model: Using the drop-down menus provided, select ONE “Line of
Business” and ONE corresponding Subfunction that most accurately describes your information collection.
15. Reporting Plan: Provide a brief description of the reporting plan for the data you will collect.
Page 5 of 6

DI-4010 (Rev. 07/2018)
U.S. Department of the Interior

OMB Control. No. 1040-0001
Expiration Date 10/31/2021

16. Justification, Purpose and Use: For questions 16A through 16F, provide a brief justification for the survey, its purpose, goals,
and utility to managers. Specifically, describe how you will tabulate the data and what the statistical techniques you will use to
generalize the results to the entire customer population. Describe how you will use the data from the survey. Describe how you
will acknowledge any limitations related to the data, particularly in cases where we obtain a lower than anticipated response rate.
Note whether you intend the survey to measure a Government Performance and Results Act (GPRA) performance measure.
17. Federal Cost: Provide the cost estimate for the Federal government to administer the information collection, along with a
description of how you calculated the cost estimate (sample response provided). Contact your bureau/office ICCO for more
information or for assistance.
18. Survey Methodology Checklist: Carefully review each item and check each box to indicate your submission provides
the required description of each item.
19. Checklist for Submitting a Request to Use DOI Programmatic Clearance for Customer Satisfaction Surveys: Carefully
review each item and check each box to indicate your understanding and concurrence of each requirement.
20. Approval Package Content: Carefully review each item and check each box to indicate your package contains each of the
requirement elements listed.
NOTE: Your survey instrument document must show the OMB Control Number 1040-0001 and Expiration Date ##/##/###, and it
MUST include the following Statements somewhere on the instrument document (preferably at the bottom of page 1 or at the end
of the document):
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 results we
will not share them 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 1040-0001, which expires ##/##/####.
Estimated Burden Statement: We estimate the [insert type of instrument] will take you ## minutes to complete,
including time to read instructions, gather information, and complete and submit your response. You may submit
comments on any aspect of this information collection to the Information Collection Clearance Officer, [Insert
Bureau/Office], [Insert mailing address].
21. Required Certifications: Completion of all information in this section is required before forwarding your approval
package to your bureau/office ICCO for review and processing.
Question 21A – Ensure the bureau/office statistician reviewing your information collection certifies the request satisfies
the requirements of the DOI Programmatic Clearance for Customer Satisfaction Surveys under OMB Control No. 10400001.
Question 21B – Ensure the requestor provides the requested contact information needed by the bureau/office and/or
Departmental ICCO to resolve questions or concerns.

Page 6 of 6