Disability Conference Overall 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: Disability Conference Overall Survey

PURPOSE: Office of Diversity & Equal Opportunity (ODEO) wants to conduct a survey to gauge their Employees with Disabilities Program Conference. This survey will be used to collect feedback from customers who attended the HQ Disability Conference held by ODEO in order to gauge NASA’s Disability Support Program. The feedback from the survey will be used to better enhance the experiences of disabled individuals here at NASA in the future and to determine satisfaction with the conference speakers and sessions.

DESCRIPTION OF RESPONDENTS:

NASA HQ Civil Servants and Contractors that attend ODEO’s HQ Disability Conference.

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: Rebecca Doroshenk

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 [x] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [x] 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 Hours
Private Sector (NASA HQ Contractors)	1,942	15 Minutes (1/4 hour)	485.5 hours
Federal Government (NASA HQ Civil Servants)	1,277	15 minutes (1/4 hour)	319.25 hours
Totals	3,219		805

FEDERAL COST:

The estimated annual cost to the Federal government is $24,150 at $30/user/hour for 3,219 [100% response rate] survey users [multiplied by the burden] 805 x $30 = $24,150.

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 HQ Employees (3,219 employees) who have attended the conference. We will administer the Survey through a link that has been provided through Microsoft Forms. We will email 100% of individuals who engaged in the Disability Conference in hopes of receiving a 50% response rate. Source of HQ Employees: IdMAX – that’s the “source of record” for identity information.

Administration of the Instrument

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

[ ] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[x] Other (HQ Users will be emailed a link to complete the survey in Microsoft Forms)

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

3