Short Statement

ASPE Generic - Short Supporting Statement cover sheet.docx

ASPE Generic Clearance for the Collection of Qualitative Research and Assessment

Short Statement

OMB: 0990-0421

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DOCUMENTATION FOR THE GENERIC CLEARANCE

FOR THE COLLECTION OF QUALITATIVE RESEARCH & ASSESSMENT


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TITLE OF INFORMATION COLLECTION:


[ ] INTERVIEWS

[ ] SMALL DISCUSSION GROUPS

[ ] FOCUS GROUPS

[ ] QUESTIONNAIRES

[ ] OTHER (EXPLAIN: )


DESCRIPTION OF THIS SPECIFIC COLLECTION

  1. Intended purpose


  1. Need for the collection


  1. Planned use of the data


  1. Date(s) and location(s)


  1. Collection procedures


  1. Number of collections (e.g., focus groups, surveys, sessions)


  1. Description of respondents/participants


  1. Description of how results will be used


  1. Description of how results will or will not be disseminated and why or why not


AMOUNT OF ANY PROPOSED STIPEND OR INCENTIVE – NONE


BURDEN HOUR COMPUTATION (Number of responses (X) estimated response or participation time in minutes (/60) = annual burden hours):


Category of Respondent

No. of Respondents

Participation Time

Burden






BURDEN COST COMPUTATION

Category of Respondent

No. of Respondents

Hourly

Rate

Response Time

Total








OTHER SUPPORTING INFORMATION


REQUESTED APPROVAL DATE:

NAME OF CONTACT PERSON:


TELEPHONE NUMBER:


DEPARTMENT/OFFICE/BUREAU:

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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleOMBMemoMERCPtP
SubjectMERC OMB MEP
AuthorHillabrant
File Modified0000-00-00
File Created2021-01-13

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