Fast Track Submission Form - CWIG Master Targeted Survey

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

TITLE OF INFORMATION COLLECTION: Child Welfare Information Gateway Master Targeted Survey

PURPOSE: Child Welfare Information Gateway (Information Gateway) is a service of the Children’s Bureau (CB), a component within the Administration for Children and Families (ACF), and is dedicated to the mission of connecting professionals and concerned citizens to information on programs, research, legislation, and statistics regarding the safety, permanency, and well-being of children and families.

The Information Gateway Master Targeted Survey is designed to solicit feedback on the following specific sections of the Information Gateway website (https://www.childwelfare.gov/):

• Management and Supervision (https://www.childwelfare.gov/topics/management/),

• Systemwide (https://www.childwelfare.gov/topics/systemwide/), and

• Child Abuse & Neglect (https://www.childwelfare.gov/topics/can/).

The Information Gateway will use the information collected in the surveys to inform website updates, design, and content, as well as several Gateway products and services, such as publications, information services work, listservs, webinars.

DESCRIPTION OF RESPONDENTS: Respondents will be visitors to the Information Gateway website who visit the designated sections, including child welfare professionals, students, and personal customers. 

TYPE OF COLLECTION:

[ ] 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 primary purpose of the results is not for public dissemination.

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 and affiliation: Beth Claxon, Child Welfare Program Specialist, ACF Administration on Children, Youth and Families (ACYF), Children’s Bureau (CB)____

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

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

Information Collection	Category of Respondent	No. of Respondents	No. of Responses per Respondent	Estimated Time per Response	Burden Hours
Child Welfare Information Gateway Master Targeted Survey	Individuals	750	1	.16	120
Totals					120

FEDERAL COST: The estimated annual cost to the Federal government is $1,855_______

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?

Visitors to the Information Gateway website will be invited to complete the survey via a pop-up window once they move their cursor off of the page itself on to the address bar of the web browser. Responses will be collected over a twelve-month period.

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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