Justification

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0970-0401)

T ITLE OF INFORMATION COLLECTION:

Adolescent Pregnancy Preventing Training & Technical Assistance

PURPOSE:

The purpose of the planned activities is to collect grantee input on the APP resource website known as “The Exchange” and to identify additional resources that grantees need to support their work in the community. This is anticipated to be a one-time survey. We believe a survey is necessary to capture a range of perspectives and experiences across all seven funding streams and diverse organizations and geographic regions.

The survey will be web-based (developed in Survey Gizmo) and sent to the grantee points of contact for response. The survey will include multiple choice and open-ended questions. We do not anticipate it will take longer than 20 minutes to complete. The contractor (RTI International) will perform analysis of the responses to inform the development of new content and products for the website, as well as distribution and promotion of the resources available to grantees.

DESCRIPTION OF RESPONDENTS:

Respondents are grantees of the Adolescent Pregnancy Prevention program.

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:__LeBretia White______________________________________________

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 Not applicable

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No Not applicable

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [ X ] No

Incentives will not be provided as the respondents are all grantees and this falls within their programming expectations; in addition, the burden of responding to the survey is low.

BURDEN HOURS

Estimated Annual Reporting Burden
Type of Collection	No. of Expected Respondents	Annual Frequency per Response	Hours per Response	Total Hours
Online questionnaire	100	1	20 min (0.33 hours)	33

FEDERAL COST: The estimated cost to the Federal government is $__5,000______

Item/Activity	Details	$ Amount
FYSB oversight of contractor and project	1% of FTE: GS-13 Program Specialist	$1,000
Deployment of survey instrument, reminders to grantees for completion, analysis of results (Contractor)	Labor hours (1.5% of FTE for contractor staff)	$4,000
Total		$__5,000______

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? [ X] Yes [ ] 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?

Each APP grant has specified points of contact. The contractor maintains a Constant Contact mailing list for each funding stream. All points of contact for all APP funding streams would receive an email message containing the link to the survey via Constant Contact. This amounts to roughly 500 contacts. All grantee contacts are eligible to respond to the survey. However, our average email open rate is 30-40% and our click-rate (percentage of respondents who click the URL in the email) is typically around 20-25%, so we are expecting only 100 recipients to respond to the survey.

Administration of the Instrument

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

[X] Web-based

[ ] 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.

The survey instrument is attached along with this form as Attachment A.

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