Our Town Program Proposed Collection

Forms and Documents

Document Name	Status
Form 1 Web Survey Instrument Form and Instruction	New
Attachment D - Final Study Plan_FINAL.docx Supplementary Document	2019-03-26
Attachment C - Cognitive Testing Report_FINAL.docx Supplementary Document	2018-10-15
Attachment A - Communication Materials_FINAL.docx Supplementary Document	2019-03-26
Supporting Statement Part B_REVISED_FINAL.docx Supporting Statement B	2019-03-26
Supporting Statement Part A_REVISED_FINAL.docx Supporting Statement A	2019-03-26

IC Document Collections

IC ID	Document Title	Status
233534	Web Survey Instrument Form and Instruction	New

ICR Details

OMB Control No: 3135-0141	ICR Reference No: 201810-3135-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: NEA	Agency Tracking No:
Title: Our Town Program Proposed Collection
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/01/2019
	Date Received in OIRA: 10/19/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2022	36 Months From Approved
Responses	381	0	0
Time Burden (Hours)	191	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This study is a new information collection request, and the data to be collected are not available elsewhere unless obtained through this information collection. A web-based survey of the National Endowment for the Arts’ (NEA) Our Town program grantees is planned for late January 2019 through mid-April 2019. Knowledge gained through this study will enable the NEA to validate or modify the Our Town program theory of change (TOC), logic model (LM), and measurement model (MM) in order to adjust grant program guidelines and grantee reporting requirements and to prepare for a future outcome evaluation study.

---

Authorizing Statute(s): US Code: 20 USC 954 Name of Law: National Foundation on the Arts and the Humanities Act of 1965
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 16402	04/16/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 52851	10/18/2018
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Web Survey Instrument	1	Our Town Evaluation Web Survey

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	381	0	0	381	0	0
Annual Time Burden (Hours)	191	0	0	191	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The information collected does not represent any program change.

---

Annual Cost to Federal Government: $55,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/19/2018

---