Request for Approval Health and Safety Fair Survey 2020

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

TITLE OF INFORMATION COLLECTION: Headquarters Health and Safety Fair Survey

PURPOSE:

NASA Headquarters promotes an annual Health and Safety Fair and all NASA HQ on-site employees are encouraged to participate. The purpose of the survey is to gather feedback from fair attendees that will be used to improve future events.

DESCRIPTION OF RESPONDENTS:

NASA Headquarters employees, including civil servants and contractors, who attend the annual Health and Safety Fair.

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: Christopher Warren, Facilities and Emergency Services Division (FESD)

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

Affected Public	No. of Respondents	Participation Time	Burden
Private Sector	~200	1 min	3.3 hours
Totals	~200	1 min	3.3 hours

FEDERAL COST: The estimated annual cost to the Federal government is: $38.50

Number of responses: 200 respondents

Response time per response: 0.016 hours

Respondent hourly wage: $7.25

Labor burden per response: $0.12

Total labor burden: $24

Contractor reviewing results: hour (2) x hourly wage ($7.25) = $14.5

Source for hourly wage information:

http://www.dol.gov/whd/minimumwage.htm

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? [ ] Yes [x] 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?

The potential group of respondents will be Headquarters employees (both civil servants and contractors) who are able to attend the annual Health and Safety Fair. Selection of participants will be voluntary and depend on willingness to complete a customer satisfaction survey to rate the event and help improve future health and safety promotion events. All attendees will have the option to respond to the survey.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[ ] Telephone

[x] In-person

[ ] Mail

[x] Other, Explain

Respondents will be handed an iPad on which to complete the survey

2. Will interviewers or facilitators be used? [ ] Yes [x] No

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