Summer of Innovation - 2012

Forms and Documents

Document Name	Status
Teacher School Year/After School Quarterly Implementation Log Form Form and Instruction	New
Summer/School Year PD Implementation Form Form and Instruction	New
Implementation Form for Student School-Year Events Form and Instruction	New
Implementation Form for Student Activities Form and Instruction	New
Teacher Follow-Up Survey Form and Instruction	New
Teacher Baseline Survey Form and Instruction	New
Student Surveys (Baseline and Follow Up) Form and Instruction	New
Parent Consent Form and Survey Form and Instruction	New
Parent Consent Form/Survey Form and Instruction	Removed
A20 screenshots.doc Supplementary Document	2011-12-27
A10 teacher survey crosswalk.docx Supplementary Document	2011-12-27
A5 student survey crosswalk.docx Supplementary Document	2011-12-27
A3 parent consent crosswalk.docx Supplementary Document	2011-12-27
Appendix E NASA SOI 3-24-11.doc Supplementary Document	2011-03-24
Appendix C NASA SOI 3-24-11.doc Supplementary Document	2011-03-24
Appendix A NASA SOI 3-24-11.doc Supplementary Document	2011-03-24
NASA SOI OMB Package Dec 11 Part B final.docx Supporting Statement B	2011-12-27
NASA SoI OMB Package Dec 11 Part A final.doc Supporting Statement A	2011-12-27

IC Document Collections

IC ID	Document Title	Status
200626	Teacher School Year/After School Quarterly Implementation Log Form Form and Instruction	New
200625	Summer/School Year PD Implementation Form Form and Instruction	New
200624	Implementation Form for Student School-Year Events Form and Instruction	New
200623	Implementation Form for Student Activities Form and Instruction	New
200622	Teacher Follow-Up Survey Form and Instruction	New
200621	Teacher Baseline Survey Form and Instruction	New
200620	Student Surveys (Baseline and Follow Up) Form and Instruction	New
200619	Parent Consent Form and Survey Form and Instruction	New
197060	Parent Consent Form/Survey Form and Instruction	Removed

ICR Details

OMB Control No: 2700-0150	ICR Reference No: 201112-2700-004
Status: Historical Inactive	Previous ICR Reference No: 201103-2700-001
Agency/Subagency: NASA	Agency Tracking No:
Title: Summer of Innovation - 2012
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 05/17/2012
	Date Received in OIRA: 12/27/2011
Terms of Clearance: At the request of the Agency, this collection is being withdrawn from OMB review.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		16 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this data collection effort is to the support the national evaluation of the SoI project. The goal of the national evaluation is formative, that is, to gather data that will inform NASA's continued development of the program as well as to assess whether evidence supports the progression to a summative, impact evaluation. Accordingly, the study will focus on SoI's implementation and associated outcomes to identify promising practices. The implementation work will develop a description of the awardee models and their local objectives prior to implementation, revealing how the planned methods are linked to desired outcomes; the data will enable us to assess the fidelity of implementation and generate lessons learned to improve future activities. We are also combining two collections, 2700-0150 and 2700-0151.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	11 FR 56	06/30/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	11 FR 56	06/30/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

IC Title	Form No.	Form Name
Parent Consent Form and Survey	n/a	Parent Consent Form and Survey
Student Surveys (Baseline and Follow Up)	n/a	Student Survey
Teacher Follow-Up Survey	n/a	Teacher Follow-Up Survey
Teacher Baseline Survey	n/a	Teacher Baseline Survey
Implementation Form for Student Activities	n/a	n/a
Implementation Form for Student School-Year Events	n/a	Implementation Form for Student School Year Events
Summer/School Year PD Implementation Form	n/a	Implementation Form for Summer and SY Professional Dev Activities
Teacher School Year/After School Quarterly Implementation Log Form	n/a, n/a	Teacher School Year Quarterly Implementation Log Form ,   Teacher After School Quarterly Implementation Log Form
Parent Consent Form/Survey	n/a, n/a, n/a	Parent Consent/Survey ,   Planning Form ,   Focus Group Protocol

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: We are combining two collections as well as making modifications to the instruments.

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Annual Cost to Federal Government: $411,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/27/2011

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