LaRC Fast track short form Safety Culture 2022

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

TITLE OF INFORMATION COLLECTION: NASA LaRC Safety Culture Survey 2022

PURPOSE: It is NASA policy to protect the NASA workforce, the public, high-value equipment/property, and the environment from potential harm as a result of NASA activities and operations by featuring safety as an integral to our programs, projects technologies, operations, and facilities. The NASA Office of Safety and Mission Assurance will collect information/feedback from individuals affiliated with NASA (contractors) to assess the status of its safety culture. The information collected will support NASA’s objective to continually improve its safety culture and prevent safety incidents from occurring.

This survey contains the general agencywide questions, as well as questions and demographic information specific to Langley Research Center (LaRC).

DESCRIPTION OF RESPONDENTS: Individuals affiliated with NASA, including civil servants, contractors, and other tenants, who work within the security perimeter of Langley Research Center (LaRC).

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 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:_Dr. Tracy Dillinger__________________________________________

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
Civil Servants	1800	7 min	210 hours
Contractors and/or Tenants	1600	7 min	187 hours
Totals	3400		397 hours

FEDERAL COST: The estimated annual cost to the Federal government is $23,026.00. Cost was estimated using an average of $58.00 as the hourly rate for the average employee/contractor and multiply it by the burden.

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?

Source of LaRC employees: IdMAX, the source of record for identity information at NASA.

Administration of the Instrument

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

[x] Web-based

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

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

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