1121-0339 Gen IC

Request for new submission under the “Generic Clearance for the Collection of Qualitative Feedback on Agency Services Delivery”

(OMB Control Number: 1121-0339

TITLE OF INFORMATION COLLECTION: Unmoderated Cognitive Testing for the 2023 Survey of Sexual Victimization Incident Forms

PURPOSE:

The SSV is an administrative data collection designed to collect information on allegations of sexual victimization by other inmates or staff that are reported to correctional and juvenile justice authorities. Additional information is collected on the victim(s), perpetrator(s), characteristics of the incident, and outcomes of substantiated incidents.

DESCRIPTION OF RESPONDENTS:

State prison systems; state juvenile correctional systems; the federal prison system; U.S. Immigration and Customs Enforcement (ICE); the U.S. military; and a sample of jail jurisdictions, privately operated adult prisons and jails, facilities in Indian country, and locally and privately operated juvenile justice facilities.

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: Cognitive testing_

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: Devon Adams_____________________

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

Note: for any privacy related questions regarding your collection, please contact your component’s Senior Component Official for Privacy or the Office of Privacy and Civil Liberties.

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X] No

If answering yes, you will also need to describe the incentive and provide a justification for the amount.

BURDEN HOURS:

In the provided table, list the following information in each row for the type or respondent for the collection and provide total figures at the bottom for the number of respondents, participation time, and burden.

• Category of respondent – Provide the type or category of individual who will respond to your collection from the following list:

  • Individuals or Household

  • Private Sector

  • State, Local, or Tribal Governments

  • Federal Government

• Number of Respondents – Estimate of the total number of respondents by type/category.

• Participation Time – Estimate of the total amount of time (in minutes) required for participation in a collection by type/category of respondents (e.g. fill out a survey or participate in a focus group).

• Burden – Estimate of the annual burden hours by type/category or respondents.

  • To determine this estimate, multiply the number of respondents by the participation time and divide that figure by 60.

Burden Table

Category of Respondent	No. of Respondents	Participation Time	Burden
State, Local and Tribal Governments	100	.25 hours	25hrs.
Totals	100		25hrs.

FEDERAL COST: The estimated annual cost to the Federal government is $948.

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?

BJS and the Census Bureau team intend to contact no more than 500 prospective respondents with the goal of getting 100 completed responses. Contacts will be sent an email invitation to complete a short questionnaire online. Respondents will be asked to provide feedback on a select number of items that will be added to incident forms. These responses will be recorded in Qualtrics and later analyzed in NVivo by researchers from DCMRB.

All participants will be informed that their response is voluntary and that the information they provide is confidential and will be seen only by Census Bureau employees and those with special sworn status.

Table of respondent types and survey instruments to be tested:

Respondent affiliation	Recruitment goal number of responders	Incident form type
State prison system	15	SSV-IA
Local jails	30	SSV-IA
Private prisons, ICE facilities, U.S. military facilities, tribal jails	15	SSV-IA
State juvenile system	15	SSV-IJ
Local or private juvenile facilities	25	SSV-IJ

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

Submit all instruments, instructions, and scripts with the request.

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