Key Elements for Gen IC Submission

Key Elements for OMB Memos under the Generic Clearance for Pretesting 0607-0725

[Title of the Study]

The Census Bureau plans to conduct additional survey work under the generic clearance for Data User Evaluation Surveys (OMB number 0607-0760).

Purpose of the Study

The Census Bureau’s [Division] ([Branch]) is planning a study to.....[reason for study].

The feedback from this survey will help the [Census Bureau/sponsor agency] decide [what?](ex. next steps for this program).

• Is this a new survey or has this survey been conducted before?

• Has it been pretested before?

• If it has been used before, explain how the information was used and if there is a report available of those results.

• If the survey was conducted previously, but there are some new items that were not asked previously, please identify these.

The key research questions or substantive issues being examined are:

• A

• B

• C

Methodology

Provide details on the administration of the study, including the mode(s), number of contacts, how you plan to notify/solicit participation of respondents to the survey and include copies of these materials as attachments.

• Dates study will be conducted

• Who will conduct the interviews?

• What pretesting methods and specific techniques are being used?

• Include protocol(s) and copies of the form and/or screen shots

• Describe anything unusual or interesting about the methodology

• Will there be observers?

• Will the interviews be audio-recorded or video-recorded? If so, attach consent form if it is not the standard form.

Respondents

• Design of the sample, including sampling frame, and how respondents will be selected

• Expected response rate and resulting sample size

• Any special screening questions and procedures (beyond previously approved screener instruments)

Burden

• Total number of potential respondents you expect to screen and burden for this screening

• [??] minutes per interview and [XX] interviews

• Total respondent burden of [??] hours.

Incentives

Incentives for time and travel expenses may be used for cognitive interviews and focus groups conducted at a place outside of the respondents’ home. The standard amounts for these activities are: $40 cognitive interviews; $75 focus groups. Any proposal to provide incentives higher than these amounts requires a strong justification as to why the target group necessitates higher incentives.

Legal

• Legal authority for collection – note title and specific section(s)

• Note that the required PRA language is conveyed to the respondent in the consent form.

Attachments

List and describe all attachments.

For further information about this study, please contact [Name] at [Telephone Number] or [Email Address].