KSC COVID-19 Vaccine Scheduling application
SUPPORTING STATEMENT
OMB Control number 2700-XXXX
INFORMATION COLLECTION TYPE: New
A. JUSTIFICATION
Kennedy Space Center (KSC) has been tasked by National Aeronautics and Space Administration (NASA) to prepare to provide COVID-19 vaccines to a prioritized set of employees. These vaccines could be provided to KSC by either the State of Florida Department of Health (via the Florida State Health Online Tracking System (SHOTS) program) or directly by the Federal Government.
Employee data, including Personally Identifiable Information (PII) such as Name, Date of Birth (DOB), Address, Sex, Race, and other medical data related to the vaccination, is required by the State of Florida to be uploaded to the Florida SHOTS website within 24 hours of vaccination. This data is also required by NASA to be entered into the Agency’s CORITY electronic health records system, and subsequently be provide to the Centers for Disease Control and Prevention (CDC).
Eventbrite will be used to gather a subset of this data electronically directly from the employee during registration in lieu of manual entry based on a completed paper form.
The information will be initially collected via an electronic process using Eventbrite. Only those employees identified as meeting the NASA Tier 1 vaccination priority criteria will be requested to enter data and schedule their vaccination appointment.
The data will be used to inform the State of Florida, NASA, and CDC on when and who was vaccinated for COVID-19 at the Kennedy Space Center.
This data will become part of the employee medical record and retained in accordance with NASA Records Retention Schedule NRRS 1441.1, AFS 01, Item 127.0.A.01.B Employee Health Records. 30 DAYS AFTER SEPARATION TRANSFER TO NATIONAL PERSONNEL RECORDS CENTER (NPRC), ST. LOUIS, MO. NPRC WILL DESTROY 75 YEARS AFTER BIRTH DATE, 60 YEARS AFTER DATE OF THE EARLIEST DOCUMENT IN THE FOLDER IF THE DATE OF BIRTH CANNOT BE ASCERTAINED, OR 30 YEARS AFTER LATEST SEPARATION, WHICHEVER IS LATER. [GRS 2.7-060]
This data can be collected manually using Florida Department of Health COVID-19 vaccination forms available on the Florida SHOTS website.
The use of Eventbrite will allow respondents to use an electronic process to submit information and facilitate transfer of the data to other systems identified above.
Employee demographic data contained in NASA IdMax/NASA Access Management System or KSC Health Unit Management System (HUMS) (e.g., home address and telephone number) may not be current. Up to date employee data needs to be collected for input to Florida Department of Health, NASA and CDC.
There is no collection of information from any small business or other small entities. Hence, there is no impact on small business or other small entities.
If the information is not collected, NASA cannot update the Florida Department of Health within the required 24 hours after vaccination, nor accurately update CORITY or CDC.
This PII and vaccine information is a legal requirement of the CDC COVID-19 Vaccination Program Provider Agreement.
There are no special circumstances as identified above, associated with this information collection.
60-day FRN: As this is an emergency clearance, a 60-day FRN was not published.
30-day FRN: Federal Register Volume 86, Number 102, on 5/28/2021.
Respondents will not receive payment or gifts.
The information collection instruments were reviewed by the KSC Coronavirus Executive Integration Team, including representation from the KSC Procurement Office, Human Resources Office, and the Office of the Chief Counsel. This collection is covered under System of Record NASA 10HIMS and a privacy statement is included on applicable forms.
Employee data, including Personally Identifiable Information (PII) such as Name, DOB, Address, Sex, Race, and other medical data related to the vaccination, is required by the State of Florida to be uploaded to the Florida SHOTS website within 24 hours of vaccination. This data is also required by NASA to be entered into the Agency’s CORITY electronic health records system, KSCs Health Record System (HUMS), and subsequently be provided to the CDC.
RESPONDENT CATEGORY |
NUMBER OF RESPONDENTS |
ESTIMATED COMPLETION TIME |
ANNUAL BURDEN |
Contractor |
2874 |
5 minutes |
238.625 hours |
Civil Servant |
462 |
5 minutes |
38.346 hours |
TOTAL |
3336 |
|
276.971 hours |
The primary burden to the applicants is the time needed to complete the application as there are no other costs associated. We estimate it will take each respondent five minutes to complete the form.
For Contractors, this cost is based on the average annual salary of a full-time Aerospace contractor paid $78,1001 per year, or $37.55 per hour. For five minutes of time, at that rate, the cost burden is $3.12 per Contractor. The total annual cost burden for Contractor registrants will be $3.12 x 2,874 = $8,966.88
For Civil Servants, this cost is based on the average annual salary of a full-time Civil Servant paid $114,6412 per year, or $54.93 per hour. For five minutes of time, at that rate, the cost burden is $4.56 per Civil Servant. The total annual cost burden for Civil Servant registrants will be $4.56 x 462 = $2,106.72.
Therefore; the total estimated annual cost burden for all registrants is approximately $11,073.60.
The estimated annualized cost burden to the Federal government is approximately $1,126.50, for administration activities associated with analyzing the data. The employee demographic data that originated in Eventbrite, must be validated, input into separate spreadsheets, and uploaded to the KSC HUMS database, the NASA CORITY database, and the State of Florida SHOTS database. This amount is based on two personnel with an average hourly wage of $37.55 x 3 hours daily, processing data for 5 days.
There have been no program changes. This is a new information collection.
This data is required by NASA to be entered into the Agency’s CORITY electronic health records system, KSC’s Health Record System (HUMS), and will subsequently be provided to the CDC.
Information gathered is not collected for external publication and will not be tabulated.
The OMB Expiration Date will be displayed on every data collection instrument.
18.
Exception to the Certificate Statement
NASA
does not take exception to the certification statements.
Name, title, and organization of NASA Information Collection Sponsor certifying statements above:
NAME: David A. Tipton, M.D.
TITLE: KSC Chief Medical Officer
ORG: Spaceport Integration & Services Directorate
1 Based on 2019 Florida Occupational Employment and Wage Rates from the U.S. Bureau of Labor Statistics: https://www.bls.gov/oes/current/oes_fl.htm
2 Based on data from the NASA Organizational Profile System
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | Supporting Statement for Paperwork Reduction Act Submission |
Author | ODIN/KSC |
File Modified | 0000-00-00 |
File Created | 2021-06-02 |