Request for Approval

DI-4014 (Rev. 07/2024)
U.S. Department of the Interior

OMB Control No. 1090-0012
Expires 02/28/2027

Request for Approval under the “Generic Clearance for
Improving Customer Experience:
OMB Circular A-11, Section 280 Implementation”
(OMB Control Number: 1090-0012)
TITLE OF INFORMATION COLLECTION:

Co-designing with (not for) Communities Focus Group
PURPOSE OF COLLECTION:
What are you hoping to learn / improve? How do you plan to use what you learn? Are there artifacts (user
personas, journey maps, digital roadmaps, summary of customer insights to inform service
improvements, performance dashboards) the data from this collection will feed?

While 101 USFWS Urban Wildlife Refuge Sites are located within 250 miles of areas across the United States
with large populations who may be challenged by high levels of poverty and low educational attainment, these
communities are rarely asked to participate in the co-design of Refuge programming that could benefit them
the most. Recent research shows one main reason residents living in poverty are not as engaged as they
could be with existing programming offered by local institutions is due to those programs not currently
considering the contexts, perspectives, and values of diverse populations (UMSL Community Innovation and
Action Center, 2019). Our project aims to correct this by co-designing Urban Wildlife Refuge Stie
programming with residents of the low-income neighborhoods surrounding those sites. To accomplish this
goal, this project will facilitate a participatory engagement process that brings community voices to the table
that have historically been excluded from similar conversations.
TYPE OF ACTIVITY: (Check one)
Customer Research (Interview, Focus Groups, Surveys)
Customer Feedback Survey
Usability Testing of Products or Services
ACTIVITY DETAILS
1. If this is a survey, will the results of this survey be reported to Touchpoints as part of quarterly reporting
obligations specified in OMB Circular A-11 Section 280?
Yes
X No
Not a survey
2. How will you collect the information? (Check all that apply)
Web-based or other forms of Social Media
Telephone
In-person
Mail
Other, Explain
3. Who will you collect the information from?
Explain who will be interviewed and why the group is appropriate for the Federal program / service to connect
with. Please provide a description of how you plan to identify your potential group of respondents and if only a
sample will be solicited for feedback, how you will select them(e.g., anyone who provided an email address to
a call center rep, a representative sample of Veterans who received outpatient services in May 2019, do you
have a list of customers to reach out to (e.g., a CRM database that has the contact information, intercept
interviews at a particular field office?)

Potential respondent consists of adults residing in Ward 4 communities in Providence, RI, as well as
all adults residing in Maryland City, North Laurel, Parkway Village, Bacontown, Laurel, South Laurel,
and Fort Meade near the Patuxent refuge in Maryland. The population is recruited based on area of
residence as well as household income with respect to the Federal poverty level.
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For phase 1 of this project, participants will be recruited by the corresponding USFWS site (with
help
from their VISTA member) at events in the target communities. We will recruit as many as 20

DI-4014 (Rev. 07/2024)
U.S. Department of the Interior

OMB Control No. 1090-0012
Expires 02/28/2027

4. How will you ask a respondent to provide this information?
(e.g., after an application is submitted online, the final screen will present the opportunity to provide feedback
by presenting a link to a feedback form / an actual feedback form)
After a participant fills out the registration form, they will be invited to one focus group where a series of
questions will be asked in-person or via Zoom online call in a group setting with 3-9 other participants who will
also be asked to provide answers to the same questions.

5. What will the activity look like?
Describe the information collection activity – e.g. what happens when a person agrees to participate? Will
facilitators or interviewers be used? What’s the format of the interview/focus group? If a survey, describe
theoverall survey layout/length/other details? If User Testing, what actions will you observe / how will you have
respondents interact with a product you need feedback on?
The facilitator will begin each Resident Focus Group by thanking participants for their attendance, adding a note about snacks and restroom location, and introducing
staff from the sponsoring organization. USFWS staff will thank the facilitator and participants and briefly highlight the purpose of the project and the importance of the
role of participants. The Sponsoring Organization wants to be the best neighbor we can be and that this is just the beginning of the conversation we hope to continue
with them over the next many years. They will then state that they will be available to answer any questions participants might have after the Small Group
Discussion and then all representatives from the Sponsoring Organization will exit the room. Two VISTAs or With (Not For) Associates will remain to take notes that
will supplement the audio recording of the discussion group. Explain that the purpose of today is to start a dialogue by asking the experts on the community—you:
the residents who live there—to tell us more about your opinion on a couple areas where the Sponsoring Organization could potentially grow in its service to the
community. There are no right or wrong answers and here are the rules we’ll follow to help move the dialogue forward: respect different opinions, do not interrupt,
wait for your turn (everyone will have), we have exactly 1 hour—be brief and stay on topic, to begin discussion about each topic. Introduction piece– The Community
Facilitator introduces themselves and their connection to the community (where they live, how long they’ve been connected to the community). The Facilitator then
asks every participant to introduce themselves and their connection to the community (where they live, how long they’ve been connected to the community)... this
should be quick 1 minute per person tops. Finally, the facilitator will begin asking a series of 9 questions.

6. Please provide your question list.
Paste here the questions or prompts presented to participants in your activity. If you have an interview /
facilitator guide, that can be attached to the submission and referenced here.
What does a thriving community look like to you?
Who or what organizations in the community do you trust to help support a thriving community?
What are your goals or dreams for your community in the next 5-10 years?
What about over the next 3-5 years?
What’s something good that you can imagine happening in your community over the next six months?
What do you currently know about how the refuge is contributing to your community now?
What are some things you think the refuge could do in the future?
How do you think that institutions in your community could collaborate with the refuge to provide more services/the services to help further strengthen
communities that thrive in your neighborhood (reference the definition of ‘thrive’ that the group defined in question #1)?
What questions do you have about the refuge at this point?

Please make sure that all instruments, instructions, and scripts are submitted with the request.
7. When will the activity happen?
Describe the time frame or number of events that will occur (e.g., We will conduct focus groups on May 13,14,15,
We plan to conduct customer intercept interviews over the course of the Summer at the field offices identified in
response to #2 based on scheduling logistics concluding by Sept. 10th, or “This survey will remain on our website
in alignment with the timing of the overall clearance.”)

We will conduct focus groups September 23 thru November 17 2024 at the two sites.
8. Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants?
Yes
No
If Yes, describe:
A $25 Visa gift card will be offered as a token of appreciation for participation. Reimbursement for travel costs
will be provided. Childcare will also be provided free of charge on site.
BURDEN HOURS
Category of Respondent

Individuals - Focus Group
Individuals - Survey
Totals

No. of
Respondents
100
100
100

Participation
Time

Burden
Hours

60 minutes
5 minutes

100
8.3

65 minutes

108.3
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DI-4014 (Rev. 07/2024)
U.S. Department of the Interior

OMB Control No. 1090-0012
Expires 02/28/2027

CERTIFICATION:
I certify the following to be true:
1. The collections are voluntary;
2. The collections are low-burden for respondents (based on considerations of total burden hours or burdenhours per respondent) and are low-cost for both the respondents and the Federal Government;
3. The collections are non-controversial;
4. Any 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 near future;
5. Personally identifiable information (PII) is collected only to the extent necessary and is not retained;
6. Information gathered is intended to be used for general service improvement and program management
purposes
7. The agency will follow the procedures specified in OMB Circular A-11 Section 280 for the required quarterly
reporting to OMB of trust data and experience driver data from surveys.
8. Outside of the quarterly reporting mentioned in the bullet immediately above, if the agency intends to
release journey maps, user personas, reports, or other data-related summaries stemming from this
collection, the agency must include appropriate caveats around those summaries, noting that conclusions
should not be generalized beyond the sample, considering the sample size and response rates. The
agency must submit the data summary itself (e.g., the report) and the caveat language mentioned above to
OMB before it releases them outside the agency. OMB will engage in a passback process with the agency.
Name and email address of person who developed this survey/focus group/interview:
Name:

Kayla Cranston, Ph.D.

Email address:

[email protected]

All instruments used to collect information must include:
OMB Control No. 1090-0012
Expiration Date: 02/28/2027

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DI-4014 (Rev. 07/2024)
U.S. Department of the Interior

HELP SHEET
(OMB Control Number: 1090-0012)

OMB Control No. 1090-0012
Expires 02/28/2027

TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the subject of the
request. (e.g. Comment card for soliciting feedback on xxxx)
PURPOSE: Provide a brief description of the purpose of this collection and how it will be used. If this is part of
a larger study or effort, please include this in your explanation.
TYPE OF COLLECTION: Check one box. If you are requesting approval of other instruments under the
generic, you must complete a form for each instrument.
CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be
returned as improperly submitted or it will be disapproved.
Personally Identifiable Information: Agencies should only collect PII to the extent necessary, and they
should only retain PII for the period of time that is necessary to achieve a specific objective.
BURDEN HOURS:
Category of Respondents: Identify who you expect the respondents to be in terms of the following
categories: (1) Individuals or Households;(2) Private Sector; (3) State, local, or Tribal governments; or (4)
Federal Government. Only one type of respondent can be selected per row.
No. of Respondents: Provide an estimate of the Number of respondents.
Participation Time: Provide an estimate of the amount of time required for a respondent to participate
(e.g. fill out a survey or participate in a focus group)
Burden: Provide the Annual burden hours: Multiply the Number of responses and the participation time
and divide by 60.

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