Office of Education Performance Assessment, Evaluation, and Information Management Data Collection Screens: One Stop Shopping Initiative (OSSI) Student-level Data

NASA Interns, Fellows & Scholars (NIFS) One Stop Shopping
Initiative (NIFS-OSSI) Data Collection Screens Usability Testing

Appendix B:

Confidentiality, Consent & Recording Release Form – Adult
Confidentiality Statement: In accordance with the Privacy Act of 1974, as amended (5 U.S.C. 552a), you
are hereby notified that this study is sponsored by the National Aeronautics and Space Administration
(NASA) Office of Education (Education), under authority of the Government Performance and Results
Modernization Act (GPRMA) of 2010 that requires quarterly performance assessment of Government
programs for purposes of assessing agency performance and improvement. NASA Education may use
the information provided for purposes related to improving the user interface of the NASA Interns,
Fellows & Scholars (NIFS) One Stop Shopping Initiative (OSSI) data collection screens (NIFS-OSSI). NASA
Education will hold the information in confidence to the full extent permitted by law. Although efforts
will be taken to ensure confidentiality, there remains a remote risk of personal data becoming
identifiable. A non-identifying code number will be assigned to participants’ data records, which will be
stored in accordance with federal regulatory procedures and accessible only to the investigator. While
qualitative data is usually analyzed in aggregate, any use of individual data to illustrate specific results
will be labeled in a manner to preserve the participants’ anonymity. Information will be secured and
removed from the NASA server and location upon guidelines set out by the NASA Records Retention
Schedule 1392, 68-69.
Introduction: This research seeks to support the mission of the NASA Office of Education by asking you
to take part in usability testing of the NIFS-OSSI data collection screens that accept applicant
information for a NASA internship, fellowship, or scholarship opportunity. The information we collect in
this usability study will help us improve the data collection screen users’ experience in regards to
wording and understanding of questions and instructions, and navigation through the data collections
screens.
Purpose of the Study: Determine the degree to which NIFS-OSSI data collections screens users are
interpreting and answering questions consistently and reliably, and determining how the user interface
is impacting the user experience.
Description of Study Procedures: You will be asked to think aloud while accomplishing a task as
described in a test scenario. A moderator will be present to remind you to think aloud, if you fall silent.
You will audio and video taped while completing the test scenario. When you complete the task as
described in the scenario, the session is complete.
Estimation of Time Required: To be determined through the testing procedure.
Contact Persons: If you have any additional questions concerning the research, this consent or
confidentiality of responses, please contact Dr. Lisa E. Wills, Senior Education Research Associate, at
lisa.e.wills@nasa.gov or call (202)258-6021.
Study Consent: There are no foreseeable risks to participants electing to participate in this study. Your
participation is completely voluntary. You may cease participation at any time. In no way does refusing
participation in this study preclude you from eligibility for NASA education project activities now or in
the future.
---TO BE MAINTAINED BY PARTICIPANT---

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I agree to participate in the study conducted and recorded by the National Aeronautics and Space
Administration (NASA) Office of Education (Education).
I understand and consent to the use and release of the recording by [[Agency/Organization]. I
understand that the information and recording is for research purposes only and that my name and
image will not be used for any other purpose. I relinquish any rights to the recording and understand the
recording may be copied and used by [Agency/Organization] without further permission.
I understand that participation in this usability study is voluntary and I agree to immediately raise any
concerns or areas of discomfort during the session with the study administrator.
Please sign below to indicate that you are 18 years of age or older, have read and understand the
information on this form, and that any questions you might have about the session have been answered.

Date:_________
Please print your name: ____________________________________________________
Please sign your name: ____________________________________________________

Thank you!
We appreciate your participation.

---TO BE MAINTAINED BY NASA EDUCATION---

https://www.usability.gov/how-to-and-tools/resources/templates/consent-recording-release-formadult.html

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