Generic Template

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 1800-0011)

TITLE OF INFORMATION COLLECTION: SEA Needs Assessment Survey, Title IV, Part A

PURPOSE: The Title IV, Part A Technical Assistance Center (T4PA Center) operates within the U.S. Department of Education (ED), Office of Safe and Supportive Schools (OSSS) and provides state education agencies (SEAs) with dedicated support in implementing the Title IV, Part A (Title IV-A) Student Support and Academic Enrichment Program. As part of this support, the T4PA Center annually develops a customized training and technical assistance (T/TA) plan for individual Title IV-A State coordinators (SCs), informed by the annual needs assessment and other needs sensing activities. Additionally, the T4PA Center delivers T/TA that effectively enhances the capacity of SCs and their staff to better assist local education agencies (LEAs) in completing their Title IV-A-funded activities.

For this sixth administration, the 2024 Needs Assessment survey will once again document the T/TA SEAs offered to their LEAs and information about the areas where they require additional T/TA. It also offers an opportunity for SCs to give feedback on the T/TA they have received from the T4PA Center within the past year. This OMB package is for the survey.

DESCRIPTION OF RESPONDENTS: SEA Title IV, Part A Coordinators or their designee

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software) [ ] Small Discussion Group

[ ] Focus Group [X] Other: TA Needs Assessment Survey

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: Hamed Negron-Perez, Title IV, Part A Group Lead

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ X] Yes [ ] No

2. If yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [X ] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ X ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
State Coordinators or their representatives	57	15 minutes	14.25 hours
Totals	57	15 minutes	14.25 hours

FEDERAL COST: The estimated annual cost to the Federal government is $30,000.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe?

[X] Yes [ ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

The potential respondents are the 57 Title IV-A State Coordinators named in the G6 system, or their designee.

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

Will interviewers or facilitators be used? [ ] Yes [X ] No

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