National Park Service
U.S. Department of the Interior

Social Science Program		
  Expedited Approval for NPS-Sponsored Public Surveys

1.	Project Title 
Submission Date:			
			
2.	Abstract:	

	
		(not to exceed 150 words)	
3.	Principal Investigator Contact Information	
	First Name:		Last Name:		
			
	Title:			
			
	Affiliation:			
	
	Street Address:			
			
	City:		State:		Zip code:			
			
	Phone:		Fax:			
			
	Email:			
4. 	Park or Program Liaison Contact Information	
	First Name:		Last Name:		
			
	Title:			
			
	Park:			
				
	Park Office/Division:			
			
	Street Address:			
			
	City:		State:		 Zip code:			
			
	Phone:		Fax:			
			
	Email:			

Project  Information
	
5.	Park(s) For Which Research is to be Conducted:		
			
6.	Survey Dates:		(mm/dd/yyyy)	to		(mm/dd/yyyy)	
		
7.	Type of Information Collection Instrument (Check ALL that Apply)	
	•	Mail-Back Questionnaire
	•	On-Site Questionnaire	•	Face-to-Face Interview	•	Telephone Survey	•	Focus Groups	
	•	Other (explain)			
	
8.	Survey Justification:
(Use as much space as needed; if necessary include additional explanation on a
separate page.)	

	
			
9.	Survey Methodology: (Use as much space as needed; if necessary include additional explanation on a
separate page.)	(a)	Respondent universe:  

(b)	Sampling plan/procedures:  

(c)	Instrument administration:  

(d)	Expected response rate/confidence levels: 

(e)	Strategies for dealing with potential non-response bias: 

(f)	Description of any pre-testing and peer review of the methods and/or instrument (recommended):

	
			
10.	Total Number of 
Initial Contacts |
Expected Respondents:			11.	Estimated Time to Complete Initial Contact | Instrument (mins.):			12.	Total Burden Hours:		
			
13.	Reporting Plan: