Information Collection

NASA Form 1355

IC 219495 under ICR 202310-2700-004 · OMB 2700-0163.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1355 NASA Form 1355	Form and Instruction
1355 Complaint of Discrimination - NASA NF1355.pdf	Form and Instruction
1355 Complaint of Discrimination - NASA NF1355.pdf	Form and Instruction
1355P Complaint of Discrimination - Public NF1355P.pdf	Form and Instruction
1355P Complaint of Discrimination - Public NF1355P.pdf	Form and Instruction

IC Title:

NASA Form 1355

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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
Form and Instruction	1355	Complaint of Discrimination - NASA	NF1355.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	1355P	Complaint of Discrimination - Public	NF1355P.pdf		Yes	Yes	Fillable Fileable

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records

Title: EEOC/GOVT1

FR Citation: 81 FR 81116

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	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.