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”
TITLE OF INFORMATION COLLECTION:
National Wildlife Refuge System Voluntary Lead-Free Pilot Program
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?

Intend to collect feedback via satisfaction survey instrument from refuge visitors engaged in hunting activities
on seven National Wildlife Refuges (NWRs) implementing the Voluntary Lead-Free Pilot Program. We will
learn about hunter views on the Program and our administration of hunting activities, which will help us to
improve the Program and our recreational hunting activities for visitors.

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
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?)

The voluntary survey will be made available to all refuge visitors engaged in designated hunting activities
during the Fall 2024/Winter 2025 season on 7 NWRs that are participating in the Voluntary Lead-Free Pilot
Program. These are elk hunting at William L. Finley NWR, deer hunting at Patoka River NWR, deer hunting at
Trempealeau NWR, deer hunting at Pocosin Lakes NWR, all hunting at Wallkill River NWR, deer hunting at
Blackwater NWR, and all hunting at Canaan Valley NWR.
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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)

Potential respondents will receive an email with a unique link to the online survey via Qualtrics.

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 survey is divided into four sections, covering the hunting activities of the respondent, the respondent’s
hunting experience, the respondents experience selecting hunting ammunition, and the respondent’s
demographic information (which is not linked to individual respondents). The Survey includes 23 total
questions, though 2 questions may be skipped in the ammunition selection section based on respondent
answers. There are no required questions, so any question may be skipped entirely while still submitting a
valid survey. The survey also allows additional open-ended comments at the end of the survey tool.
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.
The survey draws on proven questions from other sources. The main body of the survey draws on other FWS
See
attached
surveys
for hunter feedback and questions developed externally by DJ Case for a larger effort to learn about
hunter views on ammunition. The demographic questions at the end of the survey are copied exactly from
existing approved FWS surveys for customer feedback.

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 gather hunter emails as soon as this collection is approved. We will send emails to hunters as hunting
seasons end so that hunters have completed their participation in the hunting activity when responding.
However,
the hunting
vary
by species and
so we
anticipate
survey participation
run from
8.
Is an incentive
(e.g.,seasons
money or
reimbursement
of refuge,
expenses,
token
of appreciation)
provided totoparticipants?
roughlyYes
November
2024
through
spring
2025.
No
If Yes, describe:

BURDEN HOURS
Category of Respondent

Individuals
Totals

No. of
Respondents
450

450

Participation
Time
15 min

Burden
Hours
113

113
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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:

signed by CHRISTIAN MYERS
CHRISTIAN MYERS Digitally
Date: 2024.10.11 10:06:46 -04'00'

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 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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