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Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”

T ITLE OF INFORMATION COLLECTION: Directors Employee Suggestions

PURPOSE:

This evaluation is utilized as a voluntary tool for attendees of regional discussions to share their perceptions of the discussion, submit suggestions, comments, observations, and assess whether or not the discussion is achieving its desired goals. The information is aggregated and provided to discussion organizers and their leadership to guide the development of future discussions as well as determine success of the event.

DESCRIPTION OF RESPONDENTS:

Respondents will be discussion participants including military and civilians.

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: Event satisfaction 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 event or may have experience with the event in the future.

Name: CDR Leedjia Svec

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 [ X ] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No NA

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
Military and Civilian	80	5	6.3 hours
Totals	80	5 minutes	6.3hours

FEDERAL COST: The estimated annual cost to the Federal government is $45.67

Cost estimate reached from multiplying 7.25 (federal minimum wage) with 6.3 (total burden hours).

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

All discussion participants will be invited to participate in the evaluation of the discussion.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[X] Other, web based survey

2. Will interviewers or facilitators be used? [ ] Yes [ X ] No

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