Fast track form

Request for Approval under NASA’s “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 2700-0153)

1. Title of information collection	NASA Langley & Glenn Research Center Human Capital Office Customer Experience Survey Responses
2. Purpose	NASA Langley & Glenn Research Center Human Capital Offices are seeking to get feedback from customers that participate in our portfolio of Human Capital Services. This survey will gauge satisfaction with services we provide to assess effectiveness of functional areas and/or needed improvements
3. Description of respondents	Any individual that would interact with a member of the Human Capital Office team (civil servant, contractor, or the general public)

4. Type of collection (check one)

Customer comment card/complaint form	Customer satisfaction survey
Usability testing (e.g., website, software)	Small discussion group
Focus group	Other:      

5. Personally identifiable information

Will PII be collected?	Yes	No
If yes: will any information that is collected be included in records that are subject to the Privacy Act of 1974?	Yes	No
If yes: has an up-to-date System of Records Notice (SORN) been published?	Yes	No

6. Gifts or payments

Is an incentive provided to participants? (e.g., money, reimbursement of expenses, token of appreciation)

Yes

No

7. Burden time per response

Category of respondent	Number of respondents, per year	Participation time (list in minutes)	Total burden time
Individuals	100	5	8.3 hrs

8. Federal cost (If any, typically listed as the total burden time in hours x $30 = federal cost. This includes: printing, shipping, IT, contracting, and does not include salaries)

n/a

9. The selection of your targeted respondents

Do you have a customer list or similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe?	Yes	No
If yes, please provide a description of both below (attach a sampling plan if available).      
If no, please provide a description of how you plan to identify your potential group of respondents and how you will select them. Every Human Capital Office employee will have the link to the survey within one’s email signature line and any individual that engages with HCO would have the option to complete the survey.

10. Administration of the instrument (check all that apply)

Web-based or email (SurveyMonkey, MS Forms, etc)	Telephone		In person	Snail mail
Other, please list:
Will interviewers or facilitators be used?		Yes		No
Please provide the URL: https://workforce.grc.nasa.gov/ron/customer/addnew.asp

11. Certification. Please certify the following to be true

The collection is voluntary.

The collection is low-burden for respondents and low-cost for the Federal Government.

The collection is non-controversial and does not raise issues of concern to other federal agencies.

The results are not intended to be disseminated to the public.

Information gathered will not be used for the purpose of substantially informing influential policy decisions.

The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: Nicole K. Smith

Center, division, & program: NASA Langley Research Center Human Capital Office

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