EV 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	ARC Electric Vehicle Charging Survey
2. Purpose	Surveying the Ames workforce for personal electric vehicle use, parking and charging station needs. Results will inform planning, quantity, and location of chargers around the Center. These chargers are to be installed by ChargePoint at no cost to the government.
3. Description of respondents	Ames Civil Servants and Contractors, NASA Research Park tenants

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: structured 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 (best estimate)

Category of respondent	Number of respondents, per year	Participation time (list in minutes)	Total burden time (in hours)
Individuals	500	2	16.7

8. Federal cost (If any, 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). Announcement will be sent to the all employees center-wide daily newsletter
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 or email (SurveyMonkey, MS Forms, etc)	Telephone		In person	Snail mail
Other, please list:      
Will interviewers or facilitators be used?		Yes		No
Please provide the URL: https://forms.office.com/g/1a1bxeMhnY

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 of Gov’t Civil Servant SME: Lauren Wibe

Center, division, & program: ARC, JQ, Environmental Management Division, Sustainability

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