IV&V KM 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	IV&V Knowledge Management Feedback Survey
2. Purpose	To give insight to the knowledge needs of the workforce and which knowledge forums are the most beneficial.
3. Description of respondents	All IV&V employees, remote and on-site, including civil servants and contractors.

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 (best estimate)

Category of respondent	Number of respondents*, per year	Participation time (list in minutes)	Total burden time (in hours)
Federal Government	50	10	8.33 hrs
Private Sector	250	10	41.67 hrs
Totals	300	10	50 hrs

* Estimated number received, not sent out

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)

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). We intend to send the Survey to all Civil Servant and Contractors employed by the NASA IV&V Program using our org charts.
If no, please provide a description of how you plan to identify your potential group of respondents and how you will select them.      

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://forms.office.com/g/154LWquhcU?
Will the information collection be secure on a NASA approved system?		Yes	Other, explain

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 of Gov’t Civil Servant SME: Joshua D. Bell

Center, division, & program: NASA IV&V Program Analyst

12. Besides completing this fast-track form, return the following to the PRA Team:

Please provide as Word files:

• Completed fast-track form

• Screenshots of your collection instrument

• Text of your collection instrument

• Include any transmittal email, or other mechanisms, that you plan to inform recipients with

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