PSD H2O Fast Track Short Form

Request for Approval under the “Generic Clearance for the Collection

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

TITLE OF INFORMATION COLLECTION: H2O Program Participant Survey (2023-2024)

PURPOSE: The Here to Observe (H2O) Program is a monthly opportunity for undergraduate Student Observers to participate in NASA Planetary Science Division (PSD) mission meetings/activities during the 9-month academic year, alongside mentors and peers. Student Observers will be sent anonymous surveys every 3 months to assist NASA PSD with program feedback and adjustments.

DESCRIPTION OF RESPONDENTS: Undergraduate students from historically marginalized groups at non-R1 institutions awarded H2O program funding from NASA PSD.

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: _David J. Smith______________________

To assist review, please provide answers to the following question:

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
Individuals or Households	100 (quarterly)	10 minutes	66.7 hours
Totals

FEDERAL COST: $0

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

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

Potential respondents will be H2O Program Student Observers (~100 undergraduate students, total) at non-R1 institutions awarded H2O program funding from NASA PSD. The names and contact information of these students will not be established until H2O Program selections have been made for ROSES-23. We will email the Student Observer distribution list in hopes of receiving a 50% response rate for the survey. The survey will be managed and stored in a NASA-authorized G-Suite Drive used by the H2O Program Officer.

Administration of the Instrument

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

[x] Web-based

[ ] Telephone

[ ] In-person

[ ] Mail

[ x ] Other, Explain (Student Observers will be emailed a link to complete the survey in Google: https://forms.gle/RQagJt6j9akqSyEP7)

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

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

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