Fast Track PRA Submission Short Form

Status: Original and derived artifacts are available for this document.

Download: docx | pdf | html

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.