fast track form

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	Outreach 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 attendees and 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 Attendees and organizers	140	5	700 minutes or 11.6 hours

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		No
Please provide the URL:      https://forms.gle/D4bB5Sogwd8fiLE78

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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