NOAA Research & Related Personal Data

OMB Number: 0648-0568, Expires XX/XX/20XX
NOAA Research & Related Personal Data
Applicant/Project Director/Principal Investigator and Co-Applicant(s)/Project Director(s)/Co-Principal
Investigator(s)
NOAA has a continuing commitment to monitor the operation of its review and award processes to
identify and address any inequities based on gender, race, ethnicity, or disability of its proposed
applicants. To gather information needed for this important task, the applicant(s) should submit the
requested information for each identified applicant(s) with each proposal. Submission of the requested
information is voluntary and is not a precondition of award unless otherwise noted by the opportunity.
Any individual not wishing to submit some or all the information should check the box provided for this
purpose. Upon receipt of the application, this form will be separated from the application. This form will
not be duplicated, and it will not be a part of the review process (unless specified by the opportunity).
Data will be confidential.
Applicant

Section One: Name
Prefix:
First Name:
Middle Name:
Last Name:
Suffix:
Nickname or Prefered Name:
Current Affiliation/Employer:

Section Two: Personal Information
Age at date of application:
Q: What sex were you assigned at birth?
A: (check one)
● Male
● Female
● Intersex
● Prefer not to answer
Q: How do you currently describe yourself?
A: (check one)
● Male
● Female
● Non-binary
● Transgender
● Other/Self-Identify (fill in the blank)

● Prefer not to answer
Which of the following bests represents how you think of yourself?
A: (check one)
● Lesbian or Gay
● Straight
● Bisexual
● Other/Self-Identify (fill in the blank)
● I do not know the answer
● Prefer not to answer
Q: Which Categories describe you best
A: (check all that apply)
● White/Caucasian descent (For example, German, Irish, English, Italian, Polish, French, etc.) ●
Hispanic or Latin American descent (For example, Spanish, Portuguese, Mexican or Mexican
American, Puerto Rican, Cuban, Salvadorian, Dominican, Colombian, etc.)
● Black, African American, African, or Afro Caribbean descent (For example, Jamaican, Haitian,
Nigerian, Ethiopian, Somalia, etc.)
● Asian descent (For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese,
Okinawan, etc.)
● Native American or Alaska Native descent (For example, Navajo Nation, Blackfeet Tribe, Mayan,
Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.) ●
Middle Eastern or North African descent (For example, Lebanese, Iranian, Egyptian, Syrian,
Moroccan, Algerian, Israeli/Jewish, Palestinian etc.)
● Native Hawaiian or Pacific Islander descent (For example, Native Hawaiian, Samoan, Chamorro,
Tongan, Fijian, Marshallese, Palauan, Yapese, Chuukese, Pohnpeian, Kosraean, etc.) ●
Other/Self-Identify (fill in the blank)
● Prefer not to answer

Q: Disability Status Long-lasting or chronic condition (physical, visual, auditory, cognitive or mental,
emotional or other) that substantially limits one or more of your major life activities (your ability to see,
hear, or speak; to learn, remember, or concentrate):
A: (check all that apply)
● Intellectual or Learning difference
● Mobility/Orthopedic impairment
● Psychiatric condition
● Visual impairments
● Hearing impairments
● Neurological disabilities
● Chronic Illness
● Other/Self-Identify (fill in the blank)
● None
● Prefer not to answer
Q: Citizenship Status:

A:
● US Citizen
● Permanent Resident
● Other non-US Citizen
● Prefer not to answer

Section 3: Career Path Information
Q: Career Stage:
A: (check all that apply)
● Student (Currently enrolled in any degree type)
● Early Career (Up to ten years past your terminal degree) ●
Mid-Career (Ten+ years past terminal degree and pre-retirement) ●
Retired/Emeritus
● Other/Self-Identify (fill in the blank)
● Prefer not to answer
Q: Highest Degree Earned:
A: (check all that apply)
● High School or Equivalent
● Associate Degree
● Bachelor Degree
● Master Degree
● Doctorate Degree
● Other/Self-Identify (fill in the blank)
● None
● Prefer not to answer
Q: First Generation College Student/Graduate:
A: (check one)
● Yes (Parent(s) have NOT earned a bachelor's (or higher) degree) ●
No (Parent(s) have earned a bachelor's (or higher) degree) ● Unsure
(Do not know if parent(s) have earned a bachelor's degree) ● Prefer
not to answer
Q: Veteran Status:
A: (check one)
● Active Duty
● Reservist
● Veteran
● Not a Veteran
● Prefer not to answer
Q: How did you learn about this competition:
A: (check all that apply)
● Email

● Website
● College/Friend/Mentor
● Some other way (fill in the blank)
● Prefer not to answer

Next PI/Applicant
Justification:
The purpose of these questions is to track demographic trends within groups of people that work for
(FTE, contractors, or grantees), or are interns, or students, grantees with NOAA.
NOAA has a continuing commitment to monitor the operation of its review and award processes to
identify and address any inequities based on gender, race, ethnicity, or disability of its proposed
applicants. To gather information needed for this important task, the applicant(s) should submit the
requested information for each identified applicant(s) with each proposal. Submission of the requested
information is voluntary and is not a precondition of award unless otherwise noted by the opportunity.
Any individual not wishing to submit some or all the information should check the box provided for this
purpose. Upon receipt of the application, this form will be separated from the application. This form will
not be duplicated, and it will not be a part of the review process (unless specified by the opportunity).
Data will be confidential.
Some questions that relate to vulnerability may be particularly sensitive, and sharing this information
does have the potential to increase individual vulnerability when asked at the community scale. Given
these sensitivities we will wait for federal guidance that is being developed to collect this data (EO
13985, Section 9) within community surveys.
In compliance with Service Equity Assessment (EO 13985, Section 5) NOAA identified a lack of
demographic information on people that work for (FTE, contractor, or grantee), or are interns, students
or grantees of NOAA as a barrier to measuring the success of stated DEIJ goals, and gaining approval to
collect such data will be important moving forward. In collaboration with the NOAA Fellowships and
Internships Community of Practice, NOAA DEIJ in Grants Making Community of Practice, NOAA Employee
Resources Groups and the OAR EEO team we have developed a list of recommended questions.
We suggest that Race and Ethnicity be included on all surveys, but the specific categories that are
included should be specified to make it regionally relevant. For example, in the Pacific Island Region, we
would include more detailed categories of Pacific Islander identities, while in other regions, they may
wish to include more details for American Indian and Alaska Native identities, or Black or African
American identities. We recommend consulting with local authorities, and US Census data, to identify
the most relevant categories to include, and the specific term that should be used. This includes the
order of the categories to best reflect and be useful to local realities of categorization.
Race and ethnicity, which include categories that are also often used as proxies for indigenous identity,
are core components of environmental justice indicators. By including these demographic variables in
surveys, it will support vulnerability and environmental justice analysis related to disparities in capacity
and access.

Public Burden Statement
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a
person be subject to a penalty for failure to comply with an information collection subject to the
requirements of the Paperwork Reduction Act of 1995 unless the information collection has a currently
valid OMB Control Number. The approved OMB Control Number for this information collection is
0648-0568. Without this approval, we could not conduct this survey. Public reporting for this information
collection is estimated to be approximately 15 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing
and reviewing the information collection. All responses to this information collection are voluntary. Send
comments regarding this burden estimate or any other aspect of this information collection, including
suggestions for reducing this burden to the NOAA Office of Education, Natasha White,
Natasha.White@noaa.gov.
A Privacy Act Statement (PAS) is required if you are collecting PII and can retrieve information on a
specific individual using a unique identifier (name, SSN, other auto generated number). The format for a
PAS is below.
Privacy Act Statement
Authority: The collection of this information is authorized under 5 U.S.C. 301, Departmental Regulations
and 15 U.S.C. 1512, Powers and duties of Department.
Purpose: NOAA’s Office of Education proposes to collect contact information and associated background
information of undergraduate and graduate students, as well as recent graduates, for the purpose of
tracking scholarship recipients’ academic progress, making annual financial awards, and tracking
graduate studies and career progress. Demographic information will be used to measure the success of
stated Diversity, Equity, Inclusion, and Justice (DEIJ) goals only. This information will not be used to
determine program eligibility.
NOAA Routine Uses: NOAA will use this information to evaluate and assess student data and
information for the purpose of selecting successful candidates for scholarships, fellowships and
internships, generating internal NOAA reports, and articles to demonstrate the success of its program.
Disclosure of this information is permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a) to be
shared among NOAA staff for work-related purposes. Disclosure of this information is also subject to all
of the published routine uses as identified in the Privacy Act System of Records Notice
Commerce/NOAA-14, Office of Education, Educational Partnership Program (EPP); Ernest F. Hollings
Undergraduate Scholarship Program and National Marine Fisheries Service Recruitment, Training, and
Research Program.

Obligation to Respond: Furnishing this information is voluntary; however, failure to provide information
may prevent consideration of your application for the program.