Generic IC Template

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: (1190-0021)

TITLE OF INFORMATION COLLECTION:

Request for Clearance for a New Fast Track Generic Information Collection: Level 3 Evaluations: City-SPIRIT Case Study Questions

PURPOSE:

The purpose of this collection is to collect feedback from participants who attended the CRS-sponsored City-SPIRIT facilitated dialogue program and to use that information to measure the impact of the program and to ensure that the impacts are aligned with the needs of its stakeholders. In addition, CRS will change its existing program based on participant feedback.

DESCRIPTION OF RESPONDENTS:

The respondents will be participants who attended, and those who were invited to attend but did not attend the facilitated dialogue program, including faith leaders, law enforcement, facilitators, local city officials, school administrators, students, community leaders, and representatives of advocacy organizations.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form

[ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software

[ ] Small Discussion Group

[ ] Focus Group

[x] Other: Virtual interviews and online survey (SurveyMonkey)

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: Christopher Chalberg

Title: Program Manager

Office: DOJ-Community Relations Service

Desk Phone: 303.844.2975

Cell Phone: 303.301.5533

Email Address: [email protected]

_______________________________________________

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

1. CRS estimates that approximately 85-110 respondents will be involved in the information collection conducted under this clearance per year.

2. For a breakdown of this estimation, please refer to Table 1.

3. The estimated total hours spent per interview is 1 hour per interview or 30 minutes for the online survey. If all respondents choose to interview, then the estimated number of respondent burden hours is 85-110 hours per year.

4. If half of the respondents choose to interview and the other half choose to take the online survey, then the estimated respondent burden hours is 63.75-82.5 hours per year.

Table 1

Category of Respondent	No. of Respondents	Participation Time	Burden
Individual (Survey Respondent)	100	30 minutes	50 hours
Individual (Interviewee Respondent)	10	60 minutes	10 hours
Totals	110 respondents		60 hours

FEDERAL COST: The estimated annual cost to the Federal government is $0.

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?

For each program, representatives from the different program components, groups, or locations will be selected from the sign-in sheets required for each program. From the City-SPIRIT program, the respondents will be council members, planning group members, and community and city leadership including the mayor, chief of police, among others.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ x ] Other, virtual interviews and online survey (SurveyMonkey)

2. Will interviewers or facilitators be used? [ x ] Yes [ ] No