GRR Submission Form - FYSB GRR

Request for Approval under the “Generic Clearance for the Collection of Grant

Reviewer Recruiter Forms” (OMB Control Number: 0970-0477)

TITLE OF INFORMATION:
Family & Youth Services Bureau Reviewer Registry
PURPOSE:
Discretionary Grant Reviewer Recrutiment
DESCRIPTION OF RESPONDENTS:
Grant Review Participants (Reviewers, Chairpersons)
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:________________________________________________
BURDEN HOURS (Annual Bases)
Category of Respondent

No. of
Participation
Respondents Time

Burden

Reviewers

300

8 - 10 min

Low

Panel Chairpersons

100

8 - 10 min

Low

Totals
$0.00 - no addtl. cost
FEDERAL COST: The estimated annual cost to the Federal government is ____________

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Administration of the Instrument
1. How will you collect the information? (Check all that apply)
■ Web-based or other forms of Social Media
Telephone
In-person
Mail
■ Other, Explain
Electronic Form

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

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