Information Collection

NASA Enterprise Salesforce COVID-19 Contact Tracing

IC 242541 under ICR 202103-2700-001 · OMB 2700-0178.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Guided Script - Positive Outreach_v2.3 (1).docx nasahealth--nasahltuat.my.salesforce.com	Other-Data Collection
Guided Script - Positive Outreach_v2.3 (1).docx nasahealth--nasahltuat.my.salesforce.com	Other-Data Collection
Guided Script - Contact Tracing_v2.3 (1).docx nasahealth--nasahltuat.my.salesforce.com	Other-Data Collection
Guided Script - Contact Tracing_v2.3 (1).docx nasahealth--nasahltuat.my.salesforce.com	Other-Data Collection

IC Title:

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 2 14 CFR 1212.605

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
Other-Data Collection			Guided Script - Positive Outreach_v2.3 (1).docx	https://nasahealth--nasahltuat.my.salesforce.com	No		Paper Only
Other-Data Collection			Guided Script - Contact Tracing_v2.3 (1).docx	https://nasahealth--nasahltuat.my.salesforce.com	Yes	Yes	Fillable Fileable

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records

Title: NASA 10 HIMS, Health Information Management System

FR Citation: 85 FR 79224

Number of Respondents: 5,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	5,400	0	5,400
Annual IC Time Burden (Hours)	2,700	0	2,700
Annual IC Cost Burden (Dollars)	118,800	118,800	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.