Survey fast track form

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

TITLE OF INFORMATION COLLECTION: Goddard on the Green Post-event Survey

PURPOSE: NASA Goddard Space Flight Center hosted its first centerwide employee event on the “Goddard Mall” in several years. This survey will enable us to collect necessary feedback from our workforce to enhance future events of this nature.

DESCRIPTION OF RESPONDENTS: Goddard employees (civil servants, contractors, interns) that participated in the festivities.

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: Leslee Scott_______________________________

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
Private Sector (Goddard Contractors)	6,000	5 minutes (1/12 hour)	500 hours
Federal Government (Goddard Civil Servants)	3,000	5 minutes (1/12 hour)	250 hours
Other (Emeritus and Interns)	1,000	5 minutes (1/12 hour)	83.33 hours
Totals	10,000		833.33 hours

 

FEDERAL COST:  The estimated annual cost to the Federal government is $24,999.90 at $30/user/hour for 10,000 [100% response rate] survey users [multiplied by the burden] 833.33 x $30 = $24,999.90.

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

Potential respondents will be Goddard employees, approximately 10,000 employees. We will email Goddard’s workforce via our distribution listserv in hopes of receiving a 20% response rate. The source of Goddard employees for the distribution listserv is the Global Address List for identity information.

Administration of the Instrument

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

[ ] Web-based

[ ] Telephone

[ ] In-person

[ ] Mail

[x] Other, Explain (Goddard employees will receive an email blaster with the survey link (https://docs.google.com/forms/d/e/1FAIpQLSeG0LTZI7FH8qXw0JyIvchjJWScxUKhSw1wO2kujFGDzaSgcQ/viewform), which will also be included in our centerwide daily newsletter, Dateline, and on our InsideGoddard sharepoint site.

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

Please make sure that all instruments, instructions, and scripts are submitted with the request.