Template for Community Services Block Grant (CSBG) Grant Recipient Satisfaction Survey

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

TITLE OF INFORMATION COLLECTION: U.S. Department of Health and Human Services, Office of Community Services (OCS), Community Services Block Grant (CSBG) Grant Recipient Satisfaction Survey

PURPOSE: The Office of Community Services (OCS) in the Administration for Children and Families (ACF) provides Community Services Block Grant (CSBG) funding to states, the District of Columbia, the Commonwealth of Puerto Rico, U.S. Territories, federal and state-recognized tribes and tribal organizations (CSBG grant recipients) to alleviate the causes and conditions of poverty, revitalize low-income communities, and empower families and individuals with low-incomes to become self-sufficient.

Throughout the grant cycle, OCS provides training and technical assistance to the CSBG grant recipients to ensure that they operate within federal law and regulation and build accountability, and that there is continuous management improvement. In Fiscal Year (FY) 2016, OCS implemented the federal accountability measures to track organizational performance of OCS. These measures are part of an enhanced accountability and performance management framework for OCS and CSBG grant recipients. Since 2015, under a blanket clearance, OCS has collected feedback from grant recipients biennially using a satisfaction survey (OMB Control No. 1090-0007). We propose to administer another round of a survey to collect feedback from each grant recipient on their experiences and satisfaction on critical federal activities, including state and tribal plan review and acceptance; distribution of funds; grant monitoring and corrective action; and training and technical assistance. The overall purpose is to assess and improve performance for OCS. Specifically, the results of the survey will be used to (1) provide OCS with data about its performance on the federal accountability measures, (2) understand successes and challenges grant recipients experienced when engaging in critical federal activities, (3) identify lessons learned about providing technical assistance to grant recipients, and (4) identify areas for continued improvement to determine strategies for improving OCS’ customer service to the CSBG grant recipients.

DESCRIPTION OF RESPONDENTS:

Respondents include all leads from CSBG grant recipients (one survey per organization).

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: Roneika Carr, Program Specialist, Office of Community Services_

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
U.S. Department of Health and Human Services, Office of Community Services (OCS), Community Services Block Grant (CSBG) Grant Recipient Satisfaction Survey	Private Sector
	State, local, or tribal governments	118	1	12 minutes	23.6 hours
Totals		118	1	12 minutes	23.6 hours

FEDERAL COST: The estimated annual cost to the Federal government is $60,000.

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?

The survey will be distributed to all leads from the CSBG grant recipients (one survey per organization). We do not intend to sample respondents from the universe.

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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