Information Collection

NASA Form

IC 219495 under ICR 201806-2700-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 1355P NASA Form	Form
1355P NASA Complaint of Discrimination NASA Form 1355P. Complaint of Discrimination..pdf	Form

IC Title:

NASA Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	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 %

table that charts list of burden
	Approved	Previously Approved
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

table that charts IC Documents
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.