FastTrack Submission Form - FL Prototype Feedback

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

TITLE OF INFORMATION COLLECTION: Florida Prototype Project Pilot Feedback

PURPOSE: The Florida Prototype Project is a collaboration between the Children’s Bureau, the Centers for Courts and States, and the Florida Department of Children and Families (DCF) and its stakeholders. Participants in this project receive capacity building services from the Children’s Bureau and Collaborative technical assistance (TA) providers, using the Collaborative’s change management and implementation framework, tools, and resources. The Child Welfare Capacity Building Collaborative propose to collect feedback from participants that will inform future capacity building services provided to child welfare jurisdictions and their stakeholders.

This is a request for approval by the Office of Management and Budget (OMB), under the Federal Paperwork Reduction Act of 1995, for data collection activities to be authorized under the Administration for Children and Families’ generic OMB clearance # 0970-0401. Information collection activities include delivering voluntary online surveys and telephone focus groups.

DESCRIPTION OF RESPONDENTS: Survey respondents and focus group participants will include State and local governments, service providers, legal and judicial staff. An estimate of the annual response burden is outlined in the following table.

TYPE OF COLLECTION:

[ ] Customer Comment Card/Complaint Form [X] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [] Small Discussion Group

[X] 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: __Beth Claxon, Child Welfare Program Specialist, Children’s Bureau_

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

Instrument	Number of Respondents	Number of Responses per Respondent	Average Burden Hours per Response	Total Burden Hours
Florida Prototype Project Survey	46	1	.17	7.82
Florida Prototype Project Focus Group Guide	30	1	1	30

Estimated Total Annual Burden Hours: 37.82 hours

FEDERAL COST: The estimated annual cost to the Federal government is approximately __$4,974.88____

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.

Potential respondents for all data collection consist of a finite group of participants involved the Florida Prototype Project. This includes staff from the Florida Department of Children and Families (DCF), Community-Based Care (CBC) lead agencies, judicial / legal system representatives (including the Florida Court Improvement Program), youth and family members with lived expertise, and other community stakeholders (e.g., private agency providers) in Florida. Based on attendance reporting, there are an estimated 80 participants for the project meetings held between September and November 2020. Assuming a 57% response rate for surveys and 38% participation rate for focus groups from similar data collection efforts, the estimated number of respondents is 46 for the survey and 30 for the focus groups. The Florida Prototype Project Survey will be administered after the final large group meeting on November 17-18, 2020. Seven separate one-hour telephone focus groups (organized by role in the project) will be conducted in December 2020-January 2021, using the same sample for 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

[X] Telephone

[ ] In-person

[] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [X] Yes [] 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. Note: Agencies should only collect PII to the extent necessary, and they should only retain PII for the period of time that is necessary to achieve a specific objective.

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 per row.

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

Participation Time: Provide an estimate of the amount of time (in minutes) 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 Respondents and the Participation Time then 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.

Submit all instruments, instructions, and scripts are submitted with the request.

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