FastTrack GenIC Submission Form - Feedback for OFVPS Grantee Meeting

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”

(OMB Control Number: 0970-0401 Expiration 06/30/2024)

TITLE OF INFORMATION COLLECTION: Feedback for the Office of Family Violence Prevention and Services Formula Grantee Meeting

PURPOSE: The Office of Family Violence Prevention and Services (OFVPS) is hosting a Regional Meeting in June 2023. The purpose of these information collections is to collect feedback to guide the meeting and to provide feedback for internal training purposes. This request includes polling questions and a feedback survey, which will be administered to states, territories, tribes, and coalitions who attend the OFVPS, Family Violence Prevention and Services Act (FVPSA) Formula grantee regional meeting.

Polling Questions

The purpose of these questions is to engage participants in an effort to increase interaction, engagement, and participation during three Peer-to-Peer Regional breakout sessions offered for grantees to attend as part of the meeting. OFVPS will use the information to capture their experiences and engage formula grantees within the meeting sessions. Information will be collected through the Zoom platform using the polling options.

Feedback Survey

The purpose of this survey is to collect customer feedback from participants to ensure that the training workshops, and technical assistance meet grantee needs. There will be 20 training workshops offered for grantees to attend as part of the meeting and the survey will capture their experiences and feedback about the individual workshops. A list of the workshop titles are included in the attached survey. Information will be collected through an online Microsoft Forms survey format.

DESCRIPTION OF RESPONDENTS: Formula grantees including FVPSA State/Territory Administrators, primarily executive level staff at state domestic violence coalitions, and programs administrators at tribal domestic violence programs.

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 [X ] Other: _polling questions

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: Jan-Sheri Morris, Program Manager, Office of Family Violence Prevention & Services

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

Instrument	Category of Respondent	No. of Respondents	Participation Time	Burden
Polling Questions	(3) State, local, or tribal governments	300	2 minutes	10 hours
Feedback Survey	(3) State, local, or tribal governments	300	5 minutes	25 hours
Total Burden:				35

FEDERAL COST: The estimated annual cost to the Federal government is $250.00

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions: N/A

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 Family Violence Prevention and Services Act authorizes formula grants for states, territories, tribes, and coalitions that receive annual noncompetitive funding. These grant recipients are required to attend an annual grantee meeting. This includes:

• 56 state/territory administrators

• 252 tribes; and

• 56 state/territory coalitions.

The poll questions and survey will be administered to all meeting participants.

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: Paper survey of the exact questions being used on the web-based platform for the meeting.

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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