Generic Template - REL Program Customer Survey

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 1880-0542)

TITLE OF INFORMATION COLLECTION:

Regional Educational Laboratory (REL) Southeast Follow-up Stakeholder Feedback Survey

PURPOSE:

The REL Stakeholder Feedback Survey is intended to capture timely feedback on products, activities and events developed by the ten Regional Educational Laboratories. This specific Stakeholder Feedback Survey has been adapted to collect feedback from parents/caregivers, educators, and other stakeholders who participated in the Supporting Children’s Reading at Home – Family Resources for Kindergarten through 3^rd Grade webinar. The attached survey asks respondents about their satisfaction with the REL Southeast resources presented during the webinar and what dissemination approaches are most successful at supporting stakeholders’ access to the resources. .

The survey as administered will include no more than 15 items depending on how the responded responds to the questions.

Data obtained from the REL Southeast Follow-up Stakeholder Feedback Survey and Focus Groups (submitted under a separate request) will be used for program improvement purposes. Understanding how useful the REL developed resources were for parents, caregivers, and other stakeholders may result in additional modifications to the existing tool or may identify the need for future tools. It will also inform programmatic decisions related to dissemination of REL products/resources to parents and caregivers.

DESCRIPTION OF RESPONDENTS:

The category of respondents for the survey is: (1) Individuals or Households. The REL Southeast Follow-up Stakeholder Feedback Survey will be administered to participants of the Supporting Children’s Reading at Home – Family Resources for Kindergarten through 3^rd Grade webinar.

TYPE OF COLLECTION: (Check one)

[ ] 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: Janelle Sands _______________________________________________

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, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Applicable, has a System or Records Notice 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

The estimated burden hours is 51 hours per year for recording keeping purposes only.

Stakeholder Feedback Survey

Category of Respondent	No. of Respondents	Participation Time	Burden
Parents/Caregivers	100	10 minutes	17
Educators	100	10 minutes	17
Other Stakeholders	100	10 minutes	17
Totals	300	30 minutes	51

FEDERAL COST:

The estimated annual cost to the Federal government is $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?

The REL Southeast Follow-up Stakeholder Feedback Survey will be administered to participants of the Supporting Children’s Reading at Home – Family Resources for Kindergarten through 3^rd Grade webinar. REL staff will invite individuals to voluntarily complete the survey.

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.

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.

No. of Respondents: Provide an estimate of the Number of respondents.

Participation Time: Provide an estimate of the amount of time 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 responses and the participation time and 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.

Please make sure that all instruments, instructions, and scripts are submitted with the request.

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