Submission Template - OCS CED Grant Reviewer Recruitment Form

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0970-0477

TITLE OF INFORMATION COLLECTION: Community Economic Development Reviewer Registration Form

PURPOSE: This form is used to recruit and screen potential reviewers for the annual CED program application review. The form collects information about a potential reviewer’s interest and qualifications to serve as an application reviewer for the CED program. The form is being updated to gather additional information to inform whether the potential reviewer has the requisite knowledge and experience to effectively and objectively evaluate and score CED grant applications.

DESCRIPTION OF RESPONDENTS:

Applicants to become OCS grant reviewers.

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:____Lynda Perez____________________________________________

To assist review, please provide answers to the following question:

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Individuals	100	10 minutes	17 hours

FEDERAL COST: The estimated annual cost to the Federal government is ____________

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

Please make sure that all instruments, instructions, and scripts are submitted with the request.

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