fast track form

Stennis Speakers Bureau Fast Track form.docx

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

fast track form

OMB: 2700-0153

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Request for Approval under NASA’s “Generic Clearance for the Collection

of Routine Customer Feedback” (OMB Control Number: 2700-0153)


1. Title of information collection

Speakers Bureau After Action Survey

2. Purpose

To gather information from a sampling of people to measure stakeholder satisfaction, access opinions and gain other information about our Stennis events and activities from individuals who might otherwise be less likely to provide feedback.

3. Description of respondents

Event organizers


4. Type of collection (check one)

Customer comment card/complaint form

Customer satisfaction survey

Usability testing (e.g., website, software)

Small discussion group

Focus group

Other: After Action Survey


5. Personally identifiable information

Will PII be collected?

Yes

No

If yes: will any information that is collected be included in records that are subject to the Privacy Act of 1974?

Yes

No

If yes: has an up-to-date System of Records Notice (SORN) been published?

Yes

No


6. Gifts or payments

Is an incentive provided to participants? (e.g., money, reimbursement of expenses, token of appreciation)

Yes

No


7. Burden time per response

Category of respondent

Number of respondents

Participation time
(list in minutes)

Burden
time

Event organizers

120

5

600 mins / 10 hrs


8. Federal cost (Typically $30 x total burden hours = federal cost. This cost includes: printing, shipping, IT, contracting, and does not include salaries)

There is no cost associated with the surveys because they are being distributed through Google Forms, an internet-based platform. No printing, mailing, graphic design, etc., is associated with this project. However, there is an annual fee for the Google Suite access to utilize google forms ($230).


9. The selection of your targeted respondents

Do you have a customer list or similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe?

Yes

No

If yes, please provide a description of both below (attach a sampling plan if available).

A list will be developed based on event attendees.

If no, please provide a description of how you plan to identify your potential group of respondents and how you will select them.      


10. Administration of the instrument (check all that apply)

Web-based

Telephone

In person

Mail

Other, please explain:      Google Forms

Will interviewers or facilitators be used?

Yes

X No

Please provide the URL:      https://forms.gle/kEeQciuKU6qSoLcs8


11. Certification. Please certify the following to be true

The collection is voluntary.

The collection is low-burden for respondents and low-cost for the Federal Government.

The collection is non-controversial and does not raise issues of concern to other federal agencies.

The results are not intended to be disseminated to the public.

Information gathered will not be used for the purpose of substantially informing influential policy decisions.

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: Valerie Buckingham

Center, division, & program: Stennis Space Center, Office of Communications


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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorReiff, Scott (LARC-B713)[LAMPS 2]
File Modified0000-00-00
File Created2024-07-24

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