NASA OMBudsman Program User Survey

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 2700-0153)

TITLE OF INFORMATION COLLECTION:

The NASA Ombudsman Program User Survey

PURPOSE:

It is NASA's policy to provide civil servants, Center contractor workforce, and other individuals (e.g., partners, customers) working in or on a NASA-controlled facility with an informal, independent, confidential, and neutral channel to communicate and facilitate resolution of issues and concerns related to safety, organizational performance, or mission success without fear of retribution.

This information collection provides an opportunity for NASA employees to share information related to their experience with the NASA Ombudsman Program and/or their awareness of this important NASA program. Responses are not tracked back to the responder. The results will not be shared with the public.

The survey will be conducted via Microsoft Forms.

DESCRIPTION OF RESPONDENTS: NASA Civil Servants and Contractors

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: Dr. Xaivian Raymond, Executive Officer, Office of Strategic Infrastructure

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 [ ] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] 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
Individuals	1500	450 Seconds	187.5 Hours
Totals

FEDERAL COST: $8,113

Participation Time: 7.5 mins

Burden Hours: 450 Seconds x 1500 respondents = 11,250 /60 = 187.5 hours

~Average salary: $90K/Annually or 43.27/hr.

Estimated annual cost to Federal government: 187.5 hours x 43.27= $8,113

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? Yes, NASA employees with an active NASA email address.

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

Please make sure that all instruments, instructions, and scripts are submitted with the request.

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