Fast Track Memo

TAB A: Fast Track Memo

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0915-0212)

TITLE OF INFORMATION COLLECTION: Feedback and Lessons Learned from CBO Program Award Recipients

PURPOSE: Collect feedback and lessons learned from CBO Program award recipients to inform the CBO Program outcomes summary and future HRSA programs.

DESCRIPTION OF RESPONDENTS: All 158 CBO Program award recipients, will be invited to participate and provide feedback, including sub-awardee/partner organizations and community-based workers hired using CBO Program award funds.

TYPE OF COLLECTION: (Check one)

[] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software) [ ] Small Discussion Group

[X] 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 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: Fraser Byrne, Senior Advisor for CBO Program

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

Category of Respondent	No. of Respondents	Participation Time per Respondent	Burden Hours Total
CBO Program awardee (Participant)	90	1.25 hours	112.5
CBO Program awardee (Facilitator), including session and prep	10	2 hours	20
Totals	100		132.5*

* Rounds up to 133.0 in ROCIS

FEDERAL COST:

The estimated annual cost to the federal government is $91,065, which includes 1) $84,011 in salaries for staff in recruiting and scheduling focus groups, analyzing results, and creating summary reports (50% from three GS13s [$112,015] for 6 months), 2) $7,054 in project management and oversight (10% from GS14 [$141,092] for 6 months).

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?

Description: All 158 CBO Program awardees will be invited to participate and provide feedback, including sub-awardee/partner organizations and workers hired using CBO Program award funds. Once we have a pool of individuals willing to provide feedback, HRSA Evaluation Staff will schedule focus groups using our established sampling approach.

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? [X] Yes [ ] No

Focus group facilitators will be CBO Program Cooperative Agreement award recipient staff. All facilitators will be experienced and trained by HRSA to follow the attached protocol when leading the focus groups. Using facilitators that are familiar with the CBO Program and the communities served by this unique program will leverage the same trusted messenger approach that the CBO Program employed for engaging community members.

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

Attachments:

• Tab B: Focus Group Guide

• Tab C: Recruitment/Sampling Methods

• Tab D: Facilitator Recruitment Materials