Information Collection

NASA Form

IC 219495 under ICR 201508-2700-003 · OMB 2700-0163.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2700-0163 can be found here:

Documents and Forms

Document Name Document Type
Form 1355P NASA Form Form
1355P NASA Complaint of Discrimination NASA Form 1355P. Complaint of Discrimination..pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NASA Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1355P	NASA Complaint of Discrimination	NASA Form 1355P. Complaint of Discrimination..pdf		Yes	Yes	Fillable Printable

Line of Business: General Science and Innovation

Subfunction: Space Exploration and Innovation

Privacy Act System of Records
Title: 10 EEOR Equal Opportunity Records	FR Citation: 76 FR 200

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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