NRCS Energy Conservation Clearance Submission Template

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0503-0021)

TITLE OF INFORMATION COLLECTION:

Energy Conservation: Application and Opportunities Survey

PURPOSE:

The information gleaned is intended to identify opportunities for improved energy conservation delivery within NRCS. The information collected will be used to inform NRCS leadership on potential technical needs of our client base.

DESCRIPTION OF RESPONDENTS:

The respondents will be a representative group of US farmers, ranchers, and foresters from Colorado, New Mexico, and Oklahoma who do business with USDA.

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: _Survey Monkey

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:

Gilbert Guerrero, OK NRCS, Tri-State Leadership Development Program Sponsor Santiago Misquez, NM NRCS, Tri-State Leadership Development Program Participant. Cleaon Bradford, OK NRCS, Tri-State Leadership Development Program Participant.

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
Producers (farmers, ranchers, and foresters)	500	0.25	125
Totals	500	0.25	125

FEDERAL COST: The estimated annual cost to the Federal government is zero. There is no annual cost because this survey is being conducted the existing government information- communication system, GovDelivery. Staffing hours related to the project are incurred by respective state.

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 potential group of respondents will be farmers, ranchers, and foresters who are presently active participants in the GovDelivery System, those who receive email notices. The survey is voluntary; therefore, the number of actual respondents will determine statistical applicability.

The Producer survey will be compared to an NRCS employee survey to make inferences about the two groups responses.

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, Explain Survey Monkey

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 are submitted with the request.

2