Usability Testing of Reconstruction Era National Historic Network Application and Nomination Process

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;;;;.: Reconstruction Era National Historic Network

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Application
Resource Type, as identified in the Reconstruction Era Historic Network Act of 2019 (Choose one):

a

0

Property
Listed in the National Register of Historic Places?

Q Yes Q No Q Not a property

a

Facility

0 Archive

0 Library

0 Research Center

0 Other

0 Public Program

0 Tour

0 Performance

0 Living History

0 Exhibit/Art

0 Website

0 Curriculum Based

0 Youth Program

Program

0 Other

Education

(Ocscribc)

(Oescribe)

General Information

I

Resource Name

O (*required)

Resource Nam e

Street Address

O (*required)

1234 Main St

I-

State ('required)

City (*required)

Congressional District

Zip Code (*required)

0

Select -

Address No for Publication?

Has the Resource received a NPS Historic Grant in the Past? (*required)

�I

Website

O

�I I

_w_ e_bs_ _it_e _a_d_d_r e_s_s____________

Q Yes Q No

Phone Number

0

Phone Numb e r

......

I

County

Choos e ...

......

Is Resource open to public? (•required)

(i) ves Q No

I

Day

Time

Remove

Monday - Tuesday

12:00AM - 5:00AM

Remove

I

Select day

Summary of Significance

I

Start Time

Select day

End Time

Start Time

8 (•required)

Number of words:
Ownership Information

Owner/Manager

Share Contact Information?

Q Yes

I

Name

I

8

Name

Phone

8

Phone

Address

I-

8

State

I

Email

I

Email

Fax

Add Ownership/Manager

Contact Information
Jhon Dow
Share contact information? No
xxx Street
Washington, DISTRICT OF COLUMBIA
xxxxx
xxx-xxx-xxxx
xxx-xxx-xxxx
john.doe@email.com

8

Fax

City

Zip

Select -

8

End Time

ltfi/Hi

Ownership of Resource

0 Private

0 Non-Profit (50lc3)

0

0 public - Federal Government

Public - State Governemnt

0 Public - local Government

Describe the resource and it's association and significance to the Reconstruction Era in less than 1200 words. Providecitations for
sources used throughout the text if needed. Timelines are encouraged.

Additional data or comments. (Optional)

Optional pdfs of photos, brochures, or other materials to further illustrate the resource

I Choose Files I

EWIN

NOTICES
Privacy Act Statement
General: This information is provided pursuant to Public law 93-579 {Privacy Act of 1974), December 21, 1984, for individuals completing
this form.
Purpose and Uses: The Reconstruction Era National Historic Network was established, in part, to facilitate sharing of information among
those interested in the U.S. Reconstruction Era History. Putting people in contact with others who are researching related topics, historic
events, or individuals or who may have technical expertise or resources to assist with projects is one of the most effective means of
advancing reconstruction era history commemoration and preservation. Privacy laws designed to protect individual contact information
(i.e., home or personal addresses, telephone numbers, lax numbers, or e-mail addresses), may prevent NPS from making these
connections. If you are willing to be contacted by others working on civil rights movement activities and to receive mailings about African
American civil rights movement-related events, please add a statement to your letter of consent indicating what information you are
willing to share. The DOI and NPS may use the information to meet reporting requirements, to generate budget estimates and track
performance, and to assist park staff with visitors' education, fee collection, resource management and protection, recreational use
planning, law enforcement and public safety personnel for such purposes as emergency contact and search and rescue efforts; to provide
permit holders and participants with information about parks and their partners; and to provide reports of activities conducted under an
issued permit.
Disclosure: Voluntary. However, failure to provide the requested information may impede our ability to process your application. It is in
your best interest to answer all of the questions. The U.S. Criminal Code, Title 18 U.S.C. 1001, provides that knowingly falsifying or
concealing a material fact is a felony that may result in fines of up to $10,000 or 5 years in prison, or both. Deliberately and materially
making false or fraudulent statements on this form will be grounds for not approving your application.
Paperwork Reduction Act Statement : The authority to collect this information is the John D. Dingell, Jr. Conservation, Management, and
Recreation Act of 2019 (PLll6-9). We will use this information modify the functionality and usability of the on-line form used to evaluate
properties, facilities, and programs nominated for inclusion in the Reconstruction Era Network. We may not conduct or sponsor and you
are not required to respond to a collection of information unless it displays a currently valid 0MB control number. Your response is
required to obtain or retain a benefit. 0MB has approved this collection of information and assigned control number 1090-0011.
Estimated Burden Statement :Public reporting for this collection of information is estimated to average 30 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Information Collection Officer, National Park Service, 12201 Sunrise
Valley Or. (MS-242), Reston, VA 20192.

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