Ipta

NASA Information and Privacy Threshold Analysis (IPTA) Analysis Worksheet

Section 1 - System Identification
a. System Name:

Dropping in a Microgravity Experiment (DIME)

(generally the name that the system is accessed by. www.nasa.gov, when Web
enabled, for example)

b. System Owner/Information Owner:
Person responsible for funding

c. System Manager:
Person responsible for technical operation

NANCY RABEL. HALL
Phone Number:216.433.5643
E-Mail:[email protected]
Tim Reckart
Phone Number: 216-433-8147
E-Mail: [email protected]

d. Person preparing IPTA/PIA:

Nancy R. Hall
Phone Number: 216-433-5643
E-Mail: [email protected]

e. System Description:

This is a drop tower competition where students
propose experiments to drop in GRC's 2.2 second
drop tower.

f. Mission Program/Project Supported:

Education Flight Projects

g. System Security Plan Number:

OA-022-M-GRC-2202

h. System Location:

Center:GRC
Street Address:21000 Brookpark Rd
Building:77
City:Cleveland
State:OH
ZIP:44135

(Center or contractor office building, room, city and state)

i. Status of the System:

Operational

* As used in this document "System" means an organized collection of information which may encompass IT hardware systems,
applications, and databases. "System" may be an infrastructure, one or more applications, one or more databases, an electronic
information collection, or any combination thereof.

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Response

Comments

Section 2 - Privacy Impact Assessment Initial Screening
Must be completed for all systems.

a. Is this a new system or has any of
the major changes listed in the
Comments column occurred to the
system since the conduct of the last
IPTA/PIA?

New
System/Project
Previously not
assessed
Re-evaluation
Major Change

If Major Change selected, choose one of the
following
Conversions
Anonymous to Non-Anonymous
Significant System Management Changes
Significant Merging
New Public Access
Commercial Sources
Internal Flow or Collection
New Interagency Use
Alteration in Character of Data
Other (Describe):

b. Does this system/project relate solely
to an infrastructure?

Yes
No

If yes, how many applications currently reside
on infrastructure?

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Response
c. Does/Will the system contain (store)
information in identifiable form (IIF)
within any database(s), record(s), file(s)
or Web site(s) hosted by this system? If
yes, check all that apply in the
Comments column. If the category of
personal information is not listed,
please check Other and identify the
category.

Comments

Yes

Name

No

Date of birth
Social Security Number (or other number
originated by a government that specifically
identifies an individual)
Photographic identifiers (e.g., photograph
image, x-rays, and video)
Driver license
Biometric identifiers (e.g., fingerprint and
voiceprint)
Mother maiden name
Vehicle identifiers (e.g., license plates)
Mailing address
Phone numbers (e.g., phone, fax, and cell)
Medical records numbers
Medical notes
Financial account information and/or
numbers (e.g., checking account number and
Personal Identification Numbers [PIN])
Certificates (e.g., birth, death, and
marriage)
Legal documents or notes (e.g., divorce
decree, criminal records, or other)
Device identifiers (e.g., pacemaker, hearing
aid, or other)
Web Uniform Resource Locators (URL)
E-mail address
Education records
Military status and/or records
Employment status and/or records
Foreign activities and/or interests
Other (Describe):

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Response
d. Indicate all the categories of
individuals about whom IIF is or will be
collected.

NA

Comments
Categories of individuals:
Government Employees
NASA Contractors
Members of the public (excluding
contractors and partners)
Business Partners/Contacts, Grantees
(including, but not limited to federal, state, local
agencies)
Contractors/Vendors/Suppliers
Other:

e. Are/Will Records on 10 or more
members of the public containing IIF
[be] collected, maintained (stored), or
disseminated by this system?

Yes
No
NA

Section 3 - Records Management Assessment
a. Does/Will the system contain Federal
records?

Yes
No

b. If the system contains/will contain
Federal records, which disposition
authority applies?

NRRS

Retention Schedule:

GRS
Unknown or
not currently
scheduled
NA

c. Are the records in this system (or will
they be) generated in the process of
NASA program/project formulation,
design, development, or operation as
described in NPR 7120?
d. Are the records Vital records for the
organization?

Yes
No
NA
Yes
No
NA

Section 4 - Paperwork Reduction Act Assessment
a. Does/will the system collect
information in a standard way (forms,
web enabled forms, surveys,
questionnaires, etc) from members of
the public (including contractors),
regardless of format (paper, electronic
or oral)?

Yes
No

If yes, indicate format of collection:
Paper
Electronic
Oral

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Response
b. Is the information collection indicated
above authorized by an OMB Approval
Number under the Paperwork
Reduction Act (PRA)? If yes, please
provide PRA Approval Number under
Comments.

Comments

Yes

PRA OMB Approval Number:

No

Applied for

NA

Unknown/Other

Section 5 - Privacy Act Requirements Assessment
a. Are records (or will records) on
individuals be routinely retrieved from
the system by using name or a unique
identifier?

Yes
No

If yes, indicate data elements used to retrieve
record:
Name
Date of birth
Social Security Number (or other number
originated by a government that specifically
identifies an individual)
Photographic identifiers (e.g., photograph
image, x-rays, and video)
Driver license
Biometric identifiers (e.g., fingerprint and
voiceprint)
Mother maiden name
Vehicle identifiers (e.g., license plates)
Mailing address
Phone numbers (e.g., phone, fax, and cell)
Medical records numbers
Medical notes
Financial account information and/or
numbers (e.g., checking account number and
Personal Identification Numbers [PIN])
Certificates (e.g., birth, death, and
marriage)
Legal documents or notes (e.g., divorce
decree, criminal records, or other)
Device identifiers (e.g., pacemaker, hearing
aid, or other)
Web Uniform Resource Locators (URL)
E-mail address
Education records
Military status and/or records
Employment status and/or records
Foreign activities and/or interests
Other (Describe):

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Response
b. Has a Privacy Act System of Records
Notice (SORN) been published in the
Federal Register for this system? If no,
choose the reason of why not or specify
other reason in the Comments column.

Yes
No
NA

Comments
IIF is in the system, but records are not
retrieved by individual identifier.
Should have published an SORN, but was
unaware of the requirement.
System is required to have an SORN but is
not yet procured or operational.
Other (Describe):

c. If a SORN has been published, have
major changes to the system occurred
since publication of the SORN?

Yes
No
NA

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Concur:

Concur:

Concurrence Credentials on File

Concurrence Credentials on File

NANCY RABEL. HALL
System Owner

SHIRLEY A. ANDERSON
Center Privacy Manager

Date: 11/09/2010

Date: 11/09/2010

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Document History
Date

Action

Message

11/09/10

Final approval by:SHIRLEY
ANDERSON

I concur

11/09/10

Submitted to Center Privacy Manager I concur
by:NANCY HALL

11/09/10

Submitted to Application Owner
by:SHIRLEY ANDERSON

09/08/10

Rolled back to:SHIRLEY ANDERSON Back to me for changes to IPTA

09/02/10

Submitted to Center Privacy Manager Shirley - please review and let me
by:NANCY HALL
know what additional info is needed. I
know some info is blank and needs
input.

09/02/10

Submitted to Application Owner
by:NANCY HALL

Nancy - I've made some changes to
the IPTA. Please take a look and
approve. Thanks

Shirley - please review and let me
know what additional info is needed. I
know some info is blank and needs
input.

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