|
|
|
FORMS
Paperwork Reduction Act Statement - The OMB control number for this information collection is 2700-xxxx and it expires on xx/xx/2027. This information collection meets the requirements of 44 U.S.C § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995, and is part of a Federal Government-wide effort to streamline the process for seeking feedback on service delivery. This data will only be used internally for service improvement and program management purposes. We estimate it will take about 7 minutes to read the instructions, gather the facts, and answer the questions. Responses to this collection are voluntary, and you should not respond to any agency's information collection unless such collection displays a valid Office of Management and Budget control number. You may send comments on our time estimate above to [email protected]. Please send only comments relating to your time estimate to this address.
Privacy Act Statement: The information in this form will allow Agency staff members with Guest Operations responsibilities to appropriately plan for guest attendance, communicate needed information of guests, and to organize the clearance of guests at NASA facilities.
Authority: The collection is authorized by 42 U.S.C. 2451, et seq., the National Aeronautics and Space Act of 1958, as amended.
Purpose: This information is being collected and maintained for the purpose of organizing effective outreach events and registration opportunities for members of the public.
Routine uses: Use and disclosure of your records within and outside of NASA may occur in accordance with the NASA Security Records Systems (NASA 10SECR) system of records notice published at https://www.federalregister.gov/documents/2023/08/08/2023-16900/privacy-act-of-1974-system-of-records and as permitted by the Privacy Act of 1974, as amended (5 U.S.C. 552a(b)).
Impact of non-disclosure: Failing to provide the requested information may result in not being able to attend an event.
Site Registration
As of March 2025, site registration will be handled through NASA’s Agency Front Door Project. Richard Gilmore and Meghan LaCroix from NASA are working the Agency Front Door submission. Though the account creation and registration will be covered by the Agency Front Door PRA Submission, we are describing it here for context.
Fields collected through that process will include the following. This collected information will be available in NASA Special Events users seamlessly and they won’t need to re-enter it in any of the forms below unless they want to update it.
First Name
Last Name
Country
City
State
Zip
Company
Citizenship – Country if international
Interests
Optional Demographic Information: Approach has been previewed with OMB and will be in alignment and compliance with SPD 15.
Event Nominator Form
Email*
Salutation (See Appendix 1)
First Name*
Last Name*
Title*
Company*
My Company is Not Listed: Add a new Company below.
Parent Account
Account/Company Name*
Type
Description
Billing Address
Country
Street*
City*
State/Province*
Zip/Postal Code*
Citizen Status*
United States Citizen
US Lawful Permanent Resident
Non-United States Citizen
IF United States Citizen, then State of Residence* (See Appendix 3)
Nominated Party Size
1
2
3
4
5
6
7
8
9
+More
IF + More, then additional number
Preffered Viewing Site
Drop Down Dependent on What Viewing Sites are attached to event
Are you making this nomination due to a former or current capactity?
Current
Former
Stakeholder Category
Categories developed by an engagement stakeholder group and the Administrator’s Office. They are only utilitzed on the back-end of the system. Designated nominators that would be utilizing the Nominator’s form have a role with the Agency and the mission.
Academia (University Presidents, Administrators, Professors, Researchers)
A-List Celebrity
Astronaut
Cabinet Member/Staff
Climate Change Scientist or Environmental Organization Official
Community Leader (Chamber of Commerce, Business Council or other influential non-government community leaders)
DEIA Leader (affiliated with an African-American, Hispanic, Asian-American Pacific Islander, Native American, Women or LGBTQ institutions or organizations, and other)
Federal Government
Governor
Industry
Industry (Aerospace)
Influencer
International Partner
Labor Union or Trade Association Official (e.g., AIA, AIAA, AFGE, IFPTE, IEEE, PCS, etc.)
Museum/Science Center Official
NASA Advisory Council (Member)
NASA Contractor (WYE)
NASA Employee (FTE)
NASA Family/Friends of Workforce
National Space Council (UAG Member)
National Space Council Member/Staff
Nonpartisan Organization Officials (e.g., CSG, NAFIS, MISA, NACo, AASA, NGA, NASS, NSBA, USCM, NCSL, etc.)
State, Local or Tribal Government Representative
STEM Student
STEM Teacher
Student
Teacher
U.S. Congress Member/Staff
U.S. Military
White House Official/Staff
Group
Group 1: These stakeholders may directly impact the NASA mission through policy and budget activities
Group 2: These stakeholders may have an indirect impact on NASA mission activities
Group 3: These stakeholders may have a potential impact on NASA activities
Group 4: These stakeholders have no direct impact on NASA missions or budget but have some interest in our success or failure and provide essential information with minimal contact
Notes
Nominated Event RSVP Form
Select Available Event
Primary Guest First Name (uneditable)
Primary Guest Last Name (uneditable)
If any, Secondary Guest First Name (uneditable)
If any, Secondary Guest Last Name (uneditable)
Primary Guest Email
Primary Guest Phone Number
Attending Guests?
True
False
Register
This section below is asked/required depending on the event logistics. If these questions are not needed for the event, they are omitted.
ADA Accommodations
Wheelchair Access
Access to Seating
Other
Would you Party Attend Additional Attempts?
Accept All
Likely
Unlikely
Decline All
Do you Accept the Terms and Conditions?
True
False
Non-Nominated Event RSVP Form
Select Available Event
Primary Guest First Name (uneditable)
Primary Guest Last Name (uneditable)
Primary Guest Email*
Primary Guest Phone Number
Register
This section below is asked/required depending on the event logistics. If these questions are not needed for the event, they are omitted.
Select NASA PIV Badge Status
True
False
Select Citizenship Status
US Citizen
US Lawful Permanent Resident
Non-United States Citizen
Select ADA Accommodations
Wheelchair Access
Access to Seating
Other
If any, Additional Guest Details
First Name*
Last Name*
Select NASA PIV Badge Status (if needed for event)
True
False
Select Citizenship Status (if needed for event)
US Citizen
US Lawful Permanent Resident
Non-United States Citizen
Select ADA Accommodations (if needed for event)
Wheelchair Access
Access to Seating
Other
Would you Party Attend Additional Attempts?
Accept All
Likely
Unlikely
Decline All
Do you Accept the Terms and Conditions?
True
False
Event Nominee Form
Select Available Event
Salutation (See Appendix 1)
First Name*
Middle Name
Last Name*
Suffix
Guest Email (uneditable)
Title*
Company*
My Company is Not Listed: Add a new Company below.
Parent Account
Account/Company Name*
Type
Description
Billing Address
Country
Street*
City*
State/Province*
Zip/Postal Code*
Dual Citizenship (See Appendix 2)
Citizen Status*
United States Citizen
US Lawful Permanent Resident
Non-United States Citizen
This section below is asked/required depending on the event logistics. If these questions are not needed for the event, they are omitted.
NASA PIV Badge Holder
Birthdate
Drivers License Number
Drivers License State
Does Guest meet minimum event age of X? (age needed can vary by event)
Yes
No
Custom Question with open response
We have created
a field for one custom question asked of all guests if needed. We
have this help text on the field “Populate this field with a
custom question you'd like Nominees to answer when they fill out
their Nominee form. Question will display to Nominees exactly as
typed. If this question includes PII in response or something of a
sensitive nature – like demographic information – it may
require a PRA resubmission and will need to be reviewed. Please send
any possible questions of this nature to [email protected] to
start the process.
Intended uses of this include things like – Please share a message with the astronauts or Please confirm your understanding that you’ll need a private vechile at this location.
IF United States Citizen
State of Residence (See Appendix 3)
IF US Lawful Permanent Resident
18. Birthdate* (if birthdate is required for above section, it won’t be repeated here)
19. Country of Origin* (See Appendix 2)
20. Gender*
21. Passport Number*
22. Passport Country of Issuance* (See Appendix 2)
23. Passport Issue Date*
24. Passport Expiration Date*
25. Green Card Number*
26. Green Card Expiration Date*
IF Country of Origin and Passport Country of Issuance = A NASA Designated Country
Upload Green Card
IF Citizen Status = Non-United States Citizen
18. Birthdate* (if birthdate is required for above section, it won’t be repeated here)
Country of Origin* (See Appendix 2)
Gender*
Passport Number*
Passport Country of Issuance* (See Appendix 2)
Passport Issue Date*
Passport Expiration Date*
Visa Status*
Issued
Pending
Waiver Program Participant
N/A
This section below is asked/required of Non-United States Citizens depending on the event logistics. If these questions are not needed for the event, they are omitted.
26. Collect Visa Type (see Appendix 4)
27. Collect Maiden/Middle Names
28. Collect Birth City
29. Collect Permanent Home Address
Secondary Guest Information
Salutation (See Appendix 1)
First Name*
Last Name*
NASA PIV Badge Holder*
Yes
No
Dual Citizenship (See Appendix 2)
Citizen Status*
United States Citizen
US Lawful Permanent Resident
Non-United States Citizen
This section below is asked/required depending on the event logistics. If these questions are not needed for the event, they are omitted.
Birthdate
Drivers License Number
Drivers License State
Does Guest meet minimum event age of X? (age needed can vary by event)
Yes
No
Custom Question with open response
We have created
a field for one custom question asked of all guests if needed. We
have this help text on the field “Populate this field with a
custom question you'd like Nominees to answer when they fill out
their Nominee form. Question will display to Nominees exactly as
typed. If this question includes PII in response or something of a
sensitive nature – like demographic information – it may
require a PRA resubmission and will need to be reviewed. Please send
any possible questions of this nature to [email protected] to
start the process.
Intended uses of this include things like – Please share a message with the astronauts or Please confirm your understanding that you’ll need a private vechile at this location.
If US Citizen
State of Residence (See Appendix 3)
Title
Company
My Company is Not Listed: Add a new Company below.
Parent Account
Account/Company Name*
Type
Description
Billing Address
Country
Street*
City*
State/Province*
Zip/Postal Code*
IF US Lawful Permanent Resident
Birthdate*
Country of Origin* (See Appendix 2)
Gender*
Passport Number*
Passport Country of Issuance* (See Appendix 2)
Passport Issue Date*
Passport Expiration Date*
Green Card Number*
Green Card Expiration Date*
Title*
Company*
My Company is Not Listed: Add a new Company below.
Parent Account
Account/Company Name*
Type
Description
Billing Address
Country
Street*
City*
State/Province*
Zip/Postal Code*
IF Country of Origin and Passport Country of Issuance = A NASA Designated Country
Upload Green Card
IF Non-United States Citizen
Birthdate*
Country of Origin* (See Appendix 2)
Gender*
Passport Number*
Passport Country of Issuance* (See Appendix 2)
Passport Issue Date*
Passport Expiration Date*
Visa Status*
Issued
Pending
Waiver Program Participant
N/A
Title*
Company*
My Company is Not Listed: Add a new Company below.
Parent Account
Account/Company Name*
Type
Description
Billing Address
Country
Street*
City*
State/Province*
Zip/Postal Code*
This section below is asked/required of Non-United States Citizens depending on the event logistics. If these questions are not needed for the event, they are omitted.
Collect Visa Type (see Appendix 4)
Collect Maiden/Middle Names
Collect Birth City
Collect Permanent Home Address
For screen shots see: Appendix A for NASA Special Events PRA (12.18.2024)
For Appendix 1, 2, 3, and 4 see below
Appendix 1
Salutation
Mr.
Ms.
Mrs.
Miss
Dr.
Prof.
Admiral
Airman
Airman Basic
Airman First Class
Brigadier General
Brother
Cantor
Captain
Chancellor
Chief Executive
Chief Master Sergeant
Chief Petty Officer
Chief Rabbi
Chief Warrant Officer 2
Chief Warrant Officer 3
Chief Warrant Officer 4
Chief Warrant Officer 5
CLLR
Colonel
Command Chief Master Sergeant
Command Sergeant Major
Commander
Corporal
Dame
Dean
Director
Elder
Ensign
Esq.
Excellency
Father
First Lieutenant
First Sergeant
Fleet/Command Master Chief Petty Officer (CPO)
General
Grand Rabbi
Gunnery Sergeant
Her/His Eminence
Her/His Holiness
The Honorable
Hon.
Imam
Lady
Lance Corporal
Lieutenant
Lieutenant Colonel
Lieutenant Commander
Lieutenant General
Lieutenant Junior Grade
Lord
Major
Major General
Master Chief Petty Officer
Master Gunnery Sergeant
Master Sergeant
Most Hon.
Pastor
Petty Officer First Class
Petty Officer Second Class
Petty Officer Third Class
President
Principal
Private
Private First Class
Provost
Rabbi
Rear Admiral Lower Half
Rear Admiral Upper Half
Rebbetzin
Rector
Regent
Reverend
Rt. Hon.
Seaman
Seaman Apprentice
Seaman Recruit
Seaman Lieutenant
Senior Airman
Senior Chief Petty Officer
Senior Master Sergeant
Sergeant
Sergeant First Class
Sergeant Major
Shaykh
Sir
Sister
Specialist 1
Specialist 2
Specialist 3
Specialist 4
Sr. Apprentice
Staff Sergeant
Technical Sergeant
Vice Admiral
Vice-Chancellor
Warden
Warrant Officer 1
Appendix 2
Country of Origin/Dual Citizenship/Passport Country of Issuance
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burma
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Brazzaville)
Congo (Kinshasa)
Cook Islands
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Cyprus
Czechia
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Holy See
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Niue
North Macedonia
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Appendix 3
State of Residence, if U.S. Citizen
N/A
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia (D.C.)
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
US Virgin Islands
American Samoa
Baker Island
Federated Micronesia
Guam
Howland Island
Johnston Atoll
Jarvis Island
Kingman Reef
Midway Atoll
Marshall Islands
Northern Mariana Islands
Navassa Island
Palmyra Atoll
Puerto Rico
Palau
Wake Island
Appendix 4
A1
A2
A3
AM1
AM2
AM3
B1
B1/B2
B11
B12
B2
B21
B22
B23
B24
B25
B31
B32
B33
BC1
BC2
BC3
BX1
BX2
BX3
C1
C1/D
C2
C21
C22
C23
C24
C25
C3
C31
C32
C33
C51
C52
C53
CR1
CR2
CW1
CW2
CX1
CX2
CX3
D
DV1
DV2
DV3
E1
E11
E12
E13
E14
E15
E2
E21
E22
E23
E2C
E3
E31
E32
E34
E35
E3D
E3R
EW3
EW4
EW5
F1
F11
F12
F2
F21
F22
F23
F24
F25
F3
F31
F32
F33
F41
F42
F43
FX1
FX2
FX3
G1
G2
G3
G4
G5
H1B
H1B1
H1C
H2A
H2B
H3
H4
I
I51
I52
I53
IB2
IB3
IB5
IBI
IH3
IH4
IR1
IR2
IR3
IR4
IR5
IW1
IW2
J1
J2
K1
K2
K3
K4
L1
L2
M1
M2
M3
N8
N9
NATO1
NATO2
NATO3
NATO4
NATO5
NATO6
NATO7
NH1
NH2
NH3
NR1
NR2
NR3
NU1
NU2
NU3
O1
O2
O3
P1
P2
P3
P4
Q1
R1
R2
R51
R52
R53
RH1
RH2
RH3
RI1
RI2
RI3
RR1
RR2
RR3
RU1
RU2
RU3
S5
S6
S7
SB1
SC1
SC2
SD1
SD2
SD3
SE1
SE2
SE3
SF1
SF2
SG1
SG2
SH1
SH2
SI1
SI2
SI3
SJ1
SJ2
SK1
SK2
SK3
SK4
SL1
SM1
SM2
SM3
SN1
SN2
SN3
SN4
SP
SQ1
SQ2
SQ3
SR1
SR2
SR3
SS1
SU2
SU3
SU5
T1
T2
T3
T4
T5
T51
T52
T53
T6
TD
TN
U1
U2
U3
U4
U5
V1
V2
V3
VI5
|
|
|
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Reiff, Scott (LARC-B713)[eMITS] |
File Modified | 0000-00-00 |
File Created | 2025-01-14 |