Fast Track PRA Submission Short Form

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Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 2700-0153)
TITLE OF INFORMATION COLLECTION:  Safety Day 2019 Feedback Survey

PURPOSE:  To collect customer satisfaction data and suggestions from the workforce on NASA’s center-wide safety day event.  We use the feedback to improve and get ideas for upcoming center-wide safety days (for example: what kind of safety presentations, safety training, and other safety activities would be beneficial to our workforce.)

DESCRIPTION OF RESPONDENTS: Center workforce (both Civil Servants and Contractors) that attended Safety Day 2019.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form 	[ ] Customer Satisfaction Survey    
[ ] Usability Testing (e.g., Website or Software	[ ] Small Discussion Group
[ ]  Focus Group  					[X] Other: _Safety Day feedback Survey_

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: Maria L. Caballero_______________________________________________

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 – AFRC Contract Personnel
758
5 minutes
63 hours
Individuals – AFRC Civil Servant Personnel
570
5 minutes
47 hours
Totals
1328
5 minutes
110 hours

FEDERAL COST:  
The estimated annual cost to the Federal government is $6,082 at $55/user/hour for 1,328 [100% response rate] survey users.  We are hoping for a 16% response rate, which would result in 212 users that take the time to complete the survey, at an estimated annual cost to the government of $970.96.

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?

Our Center Executive Assistant has a global list of the Center employees, AFRC-DL-Public, (both Civil Servants and contractors) that is owned by the Armstrong Flight Research Center (AFRC) Help Desk.  This distribution list is comprised of all users at AFRC with a Nomad (email) account that have been added (to the list) by the help desk.  There are currently 1,328 total users at AFRC with a Nomad account, verified by running a NASA Access Management System (NAMS) report.  The Civil Servant DL has 570 entries, leaving 758 contractor personnel. I craft the e-mail with the link to the survey and send it to our Center’s Executive Assistant to forward to the entire Center workforce using AFRC-DL-Public after they have attended the event.  



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

https://docs.google.com/forms/d/e/1FAIpQLSdRyVG2Rkf6VGfvAOIGLGMNAA79nKBq8I8_vtJWZTKtZFCzjQ/viewform?vc=0&c=0&w=1

    2. Will interviewers or facilitators be used?  [  ] Yes [X] No
 
Please make sure that all instruments, instructions, and scripts are submitted with the request.