Earthrise 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	Earthrise Feedback Questionnaire
2. Purpose	To collect customer satisfaction reflections and feedback from recipients of the Earthrise Newsletter. Feedback will be used for continuous improvement purposes and planning efforts for future Earthrise Newsletter information with Earth and climate science educational resources.
3. Description of respondents	The targeted group of respondents includes the distribution route list of recipients of the Earthrise Newsletter. These individuals represent educators (e.g., Elementary, Middle, and High School Teachers; Informal Educators; Higher Education Faculty; Preservice Teachers; Homeschool Educators, etc).

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:      

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
Educators (Recipients of the Earthrise Newsletter)	1700	5 minutes	141.67 hours

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

      0

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). The Earthrise Newsletter distribution route list has over 3000 registered individuals however, the universe of potential respondents to this survey is ~1700 educators that we estimate might complete this survey. The targeted sampling approach focuses on a 50% response rate goal of educator respondents (~1700 individuals).
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:      
Will interviewers or facilitators be used?		Yes		No
Please provide the URL: https://www.surveymonkey.com/r/SYCZTZJ

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: Richard L. Gilmore Jr.

Center, division, & program: NASA GRC, Office of STEM Engagement (OSTEM), Performance and Evaluation (P&E)

12. Besides completing this fast-track form, return the following to the PRA Team:

Please provide as Word files:

• Completed fast-track form

• Screenshots of your collection instrument

• Text of your collection instrument

• Include any transmittal email, or other mechanisms, that you plan to inform recipients with

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