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Request for approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0704-0553)

TITLE OF INFORMATION COLLECTION:

User feedback from the 2024 DOD Survivor Symposium

PURPOSE:

Military Community and Family Policy would like to request feedback from those who attended the Defense Department’s first Survivor Symposium. The feedback form will determine if the symposium and the information presented further the department’s commitment to supporting survivors of active-duty deaths, including helping survivors understand all benefits and forms of assistance.

Request completion of an online feedback form with the following audience segment:

• Attendees of the 2024 DOD Survivor Symposium

The objectives of the feedback form are to determine:

• Attendee satisfaction with the DOD Survivor Symposium

• Relevance of the information covered in the DOD Survivor Symposium

• Frequency of future DOD Survivor Symposiums

• Topics covered in future DOD Survivor Symposiums

DESCRIPTION OF RESPONDENTS:

Potential respondents are attendees of the 2024 DOD Survivor Symposium. After the symposium, they will receive an email with a link to complete the online feedback. Participation is voluntary.

TYPE OF COLLECTION: (Check one)

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

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

[ ] Focus Group [ ] Other: ____________

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: Jean Gibbs

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

Personally Identifiable Information:

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

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

3. If Yes, has an up-to-date System of Records Notice (SORN) 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
Surviving family members	200	5 mins	16.7
Service providers	150	5 mins	12.5
Other	50	5 mins	4.2
Totals	400	5 mins	33

Attendees of the 2024 DOD Survivor Symposium will be given the opportunity to provide their feedback via an online feedback form. The estimated burden of time per response averages five minutes. The deadline for registering is June 21, 2024.

PUBLIC COST: The estimated annual cost to the public is $ 1,254.00.

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.

Potential respondents are attendees of the 2024 DOD Survivor Symposium, and they will be provided with a link to the online feedback form to provide feedback, if they choose to do so. 

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

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

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