Generic One Pager

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

TITLE OF INFORMATION COLLECTION: Aviano Air Base Where Airmen Get Information

PURPOSE: To collect information from those stationed at Aviano Air Base as well as spouses on how they currently receive information that the base distributes and what channels they would like to get information on to better communicate with our audience in the future.

DESCRIPTION OF RESPONDENTS: Active duty Air Force and Army Stationed at Aviano Air Base and spouse dependents stationed at Aviano Air Base.

TYPE OF COLLECTION:

[ ] 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: ___1 Lt Danielle Lucero _____________________________________________

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

Category of Respondent	No. of Respondents	Participation Time	Burden
Public Individuals and Households	2,000	5 min	166 hours
Federal Government (Military and Civilian)	4,400	5 min	367 hours
Totals	6,400	5 min	533 hours

PUBLIC COST: The estimated annual cost to the public is ___$1,203.50_________

Hourly public wage was determined from the Federal Minimum Wage of $7.25 per hour.

166 hours x $7.25 = $1,203.50

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?

The survey will be sent out through a weekly email that goes to the base, as well as to key spouse organizations and to Commanders and 1^st Sgts.

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.

Submit all instruments, instructions, and scripts with the Request for Approval.

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