Fast Track GenIC Submission Form - nFORM 2.0 Help Desk Customer Service Feedback Surveys

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

T ITLE OF INFORMATION COLLECTION: nFORM 2.0 Help Desk Customer Service Feedback Surveys

PURPOSE: The Administration for Children and Families (ACF) requests approval to collect customer service feedback on a web-based Help Desk we oversee for questions related to a management information system called nFORM 2.0 (Information, Family Outcomes, Reporting, and Management). The system is used by 112 Healthy Marriage and Responsible Fatherhood (HMRF) grantees funded by ACF to collect and report on required performance measures. A prior cohort of HMRF grantees used an earlier version of the nFORM system and provided feedback on the system’s Help Desk using the survey in this request.

ACF has contracted with Mathematica to manage both the nFORM 2.0 system and the Help Desk. Feedback will help ACF improve nFORM 2.0 Help Desk assistance provided by Mathematica.

DESCRIPTION OF RESPONDENTS: HMRF grantee staff who use the system and submit questions to the nFORM 2.0 Help Desk will be invited to respond to customer service feedback surveys about their Help Desk experiences.

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: Katie Pahigiannis, PhD, MPH; ACF Office of Planning, Research, and Evaluation

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

We propose to email customer service feedback surveys once per quarter (every three-month period) to any HMRF grantee staff member who submitted an nFORM Help Desk ticket (i.e. request) during that quarter. The email will contain a link to the web-based survey. We will send one reminder email and then assess the need for a second reminder email to increase response rates. The estimated annual burden hours for grantee staff to complete the survey is presented in the table below.

Category of Respondent	No. of Respondents per survey	No. of Responses per respondent	Participation Time	Burden
Private sector (HMRF grantee staff who submit tickets to the nFORM 2.0 Help Desk)	152	4	5 min	51 hours

FEDERAL COST: The estimated annual cost to the Federal government is $3,404.

For cost calculations, we take into account the time needed for multiple ACF staff to oversee the distribution of the survey and review customer feedback. We estimate this will take 60 hours per year split equally between federal ACF staff at the GS-12, GS-13, and GS-14 levels.

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?

We will identify the universe of respondents based on their requests to the nFORM 2.0 Help Desk. The entire universe of respondents will be surveyed; we will not select a sample.

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. 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 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.

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

6