TITLE
OF INFORMATION COLLECTION: I am Moving, I am Learning (IMIL)
Feedback Survey
PURPOSE: The proposed information collection will be administered to participants of the National Center on Health, Behavioral Health, and Safety (NCHBHS) I am Moving, I am Learning (IMIL) Training on behalf of the Office of Head Start. This user feedback survey will provide timely feedback from current participants in an efficient manner to improve future trainings. This is the sole source of satisfaction data to be collected from participants of the IMIL Training. Responses to this survey will be used to inform planning and improvement of the service delivery.
DESCRIPTION OF RESPONDENTS: This user feedback survey will be administered to participants attending the NCHBHS IMIL Training. The survey will be delivered through an online survey. This includes Head Start and Early Head Start recipient staff.
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:
The collection is voluntary.
The collection is low-burden for respondents and low-cost for the Federal Government.
The collection is non-controversial and does not raise issues of concern to other federal agencies.
The primary purpose of the results is not for public dissemination.
Information gathered will not be used for the purpose of substantially informing influential policy decisions.
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: Marco Beltran, Senior Head Start Program Specialist, Office of Head Start
To assist review, please provide answers to the following questions:
Personally Identifiable Information:
Is personally identifiable information (PII) collected? [ ] Yes [X] No
If Yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No
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 |
Anonymous online survey |
Participants of IMIL Training |
150 |
1 |
5 minutes |
12 |
Totals |
150 |
|
|
12 |
FEDERAL COST: The estimated annual cost to the Federal government is _$250_______
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
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 link to the survey will be provided to all registered participants of the IMIL Training at the end of the training by e-mail.
Administration of the Instrument
How will you collect the information? (Check all that apply)
[X] Web-based or other forms of Social Media
[ ] Telephone
[ ] In-person
[ ] Other, Explain
Will interviewers or facilitators be used? [ ] Yes [X] No
Please make sure that all instruments, instructions, and scripts are submitted with the request.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | DOCUMENTATION FOR THE GENERIC CLEARANCE |
Author | 558022 |
File Modified | 0000-00-00 |
File Created | 2024-07-24 |