Information Collection

NASA STI Impact Questionnaire

IC 199121 under ICR 201105-2700-002 · OMB 2700-0153.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2700-0153 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NASA STI Impact Questionnaire	Form and Instruction
STI Impact Questionnaire.docx	Form and Instruction
STI Impact - Request Form.docx Supporting Statement	IC Document

IC Title:

NASA STI Impact Questionnaire

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	n/a	STI Impact Questionnaire.docx		Yes	Yes	Fillable Fileable

Line of Business: General Science and Innovation

Subfunction: Space Exploration and Innovation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	STI Impact - Request Form.docx	09/02/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.