Gatherings GenIC - Administration for Native Americans Registration Form

Request for Approval under the “Administration for Children and Families Generic for Information Collections Related to Gatherings”

(OMB Control Number: 0970-0617)

TITLE OF INFORMATION COLLECTION: Administration for Native Americans Registration Form

PURPOSE: The Administration for Native Americans (ANA) Registration Form serves as an essential tool for collecting participant information to facilitate effective training and workshop experiences. This form gathers personal and professional details—including contact information, tribal or organizational affiliations, and grant identifiers—to ensure appropriate preparation and follow-up for each attendee.

DESCRIPTION OF RESPONDENTS: Survey respondents will tribal governments, Indian Tribes and tribal organizations, Alaska Native grantees, and non-profit Native American organizations.

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 information collected is not intended to be disseminated to the public¹.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

Name and affiliation: Amy Zukowski, Director, Program Evaluation and Planning, ANA

To assist review, please provide the following information:

BURDEN HOURS

Instrument Title	Category of Respondent	No. of Respondents	Participation Time	Burden
Administration for Native Americans Registration Form	Tribal Governments and Private Sector	300	10 minutes	50

We estimated the total cost by using the Bureau of Labor Statistics wage data for Social and Human Services Assistants (job code 21-1099). The mean hourly wage from May 2024 is $28.06 per hour. To account for fringe benefits and overhead the rate was multiplied by two which is $56.12. The estimate of annualized cost to respondents for hour burden (inclusive of fringe and overhead) is $56.12.

FEDERAL COST: The estimated annual cost to the Federal government is $5,806

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

Please make sure that all instruments, instructions, and scripts are submitted with the request.

1 The information collected through this request is primarily for internal review and will not be published. However, for certain activities information submitted by accepted participants, such as research abstracts to be presented in a poster session, may be published on an ACF website or included in a printed or online program for the activity or subsequent publication describing the activity.

2