FEPA short form

Request for Approval under the “Generic Clearance for the Collection of
Routine Customer Feedback” (OMB Control Number: 3046-0048)

TITLE OF INFORMATION COLLECTION:
FEPA Training Conference Survey
PURPOSE:

Title VII of the Civil Rights Act of 1964, as amended, allows the EEOC to cooperate with state
and local agencies to carry out its investigatory functions, see 42 U.S.C. §2000e-8(b), and
pursuant to that authority the EEOC has entered into worksharing agreements and contracts with
state and local Fair Employment Practices Agencies (FEPAs) for the processing of charges of
discrimination. These agreements allow for dual filing of charges with the EEOC and the FEPA
when both federal and state laws cover the allegations made in the charges, with some dual-filed
charges being investigated by the EEOC and some by the FEPAs. As part of the agreements with
these state and local agencies, the EEOC annually sponsors a training conference for its FEPA
partners. At the conclusion of each course, the EEOC seeks feedback from participants on the
effectiveness of the presentation.
DESCRIPTION OF RESPONDENTS:
Employees of the state and local Fair Employment Practices Agencies who attend the annual
EEOC-sponsored FEPA training conference.
TYPE OF COLLECTION: (Check one)
[ ] Customer Comment Card/Complaint Form
[ ] Usability Testing (e.g., Website or Software
[ ] Focus Group

[x] Customer Satisfaction Survey
[ ] Small Discussion 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: Michelle Crew, Program Analyst, EEOC Office of Field Programs, Revolving Fund
Division/EEOC Training Institute
To assist review, please provide answers to the following question:
Personally Identifiable Information:

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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
(3) State or local government – FEPA Conference
Attendees
Totals

No. of
Participation
Respondents Time
550
2 minutes per
response
550
2 minutes per
response

Annual
Burden
18
hours
18
hours

FEDERAL COST: The estimated annual cost to the Federal government is based on the hourly
rate of a GS-13 employee who dedicates 1% of labor hours, a GS-14 employee who dedicates
less than 1% of labor hours, a SES employee who dedicates less than 1% of labor hours and the
cost of materials/and or software.
Federal Cost Formula:
GS-13 employee hours spent on task (10) x employee pay rate ($50) = $500
GS-14 employee hours spent on task (6) x employee pay rate ($70) = $420
SES employee hours spent on task (2) x employee pay rate ($105) = $210
Software and/or materials = $500
Total Federal Cost $500+$420+$210+$500 = $1630
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?
All participants in the training event will be asked to provide feedback on their
experience.
Administration of the Instrument
1. How will you collect the information? (Check all that apply)
[ ] Web-based or other forms of Social Media
[ ] Telephone
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[x] 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.

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