FastTrack GenIC Submission Form - 2022 ANA Grantee Meeting Planning Feedback

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

TITLE OF INFORMATION COLLECTION: 2022 ACF Native American Pre-Grantee Meeting Survey

PURPOSE: The Administration for Children and Families (ACF) would like to collect feedback from potential attendees at the 2022 ACF Native American Grantee Meeting. The proposed survey would allow them to provide input on travel, content, as well as the theme and workshops for the 2022 ACF Native American Grantee Meeting. Data collected from the proposed feedback survey will be used to help the Administration for Native Americans (ANA) to plan this meeting.

DESCRIPTION OF RESPONDENTS: The targeted respondents are ACF grantees and cooperative agreement recipients. This includes tribal governments, Indian Tribes and tribal organizations, Alaska Native grantees, and non-profit Native American organizations. An estimate of the annual response burden is outlined in the following table.

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: Amy Zukowski, ACF Administration for Native Americans

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
State, local, or tribal governments	200	10 minutes	33hours
Private sector	200	10 minutes	33 hours
Totals	400	10 minutes	67 hours

FEDERAL COST: The estimated annual cost to the Federal government is approximately $650.

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?

ACF is hosting the 2022 ACF Native American Grantee Meeting. The group of respondents are ACF grantees. The survey will be deployed as an electronic 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

[ ] 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.

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