Justification

Request for Approval under the “Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery”

(OMB Control Number: 2030-0051; EPA ICR Number: 2434.272)

TITLE OF INFORMATION COLLECTION: Oʻahu Climate Champions Final Reflection

PURPOSE:

In contrast to the Climate Champions monthly reflection survey, this survey will be given once, at the end of the summer. The purpose of this survey is to assess the overall impressions and feedback from participants in the Oʻahu Climate Champions program about their experience so that the City and County of Honolulu can make necessary program improvements.

DESCRIPTION OF RESPONDENTS:

Respondents will include Climate Champions, who are part-time summer interns hosted by a community-based organizations around the island, and their supervisors, usually a staff member from the community-based organization. The project will run for three years, so there will be 3 cohorts of champions over the course of the program, while the supervisors are expected to remain the same.

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 [ ] Other: ______________________

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	Burden
Individuals	30	10 minutes	300 minutes
Totals	30	10 minutes	5 hours

FEDERAL COST: The estimated annual cost to the Federal government is: $ 0.00

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?

Respondents will be participants in our Climate Champions program. The total universe is extremely small () so no sampling is necessary.

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.

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: Dominique Smith

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