Generated Narrative: Questionnaire HERAAnalogMissionApplication Structure LinkID Text Cardinality Type Description & Constraints HERAAnalogMissionApplication Application for the Human Exploration Research Analog (HERA) mission at NASA Johnson Space Center Questionnaire http://example.org/Questionnaire/hera-analog-mission-application#0.5.12 #xD; intro Application for Analog Missions. Additional information regarding HERA studies at the Johnson Space Center including a video tour of the HERA facility can be found on the NASA website. Before applying to be a study participant we ask that you review this information for a better understanding of what your participation would entail if chosen as a subject for a future HERA mission. 0..1 display #xD; privacy-statement Privacy Act Statement: Pursuant to the Privacy Act of 1974, 5 U.S.C. § 552a, the following statement is furnished to individuals applying to become ground study subjects for the Flight Analog Project. Authority: This collection is authorized by 51 U.S.C. 20113(a) and 44 U.S.C. 3101. Purpose: We will use the information to determine eligibility for the Flight Analog Project. Effect of Nondisclosure: Supplying the information is voluntary on your part. However, failing to provide all or part of the information may prevent an accurate and timely decision on your application. 0..1 display #xD; consent By submitting this form, you consent to adding your responses to the analog subject registry. After reviewing your responses, further information may be requested. You may withdraw your information from this registry at any time by sending an e-mail to the recruitment team. 0..1 display #xD; citizenship Are you a United States citizen? 1..1 boolean #xD; confinement-consent For HERA missions, are you willing to be confined and isolated for required periods of time? 1..1 boolean #xD; confinement-details HERA mission duration includes a confined isolation of 45 days. In addition to the isolation phase, each mission includes 16 days of pre-mission data collection and training and 7 days of post-mission data collection, requiring a stay in Houston, TX of up to 72 days. 0..1 display #xD; demographic-info Demographic Information 1..1 group #xD; firstName First Name 1..1 string #xD; middleName Middle Name 0..1 string #xD; lastName Last Name 1..1 string #xD; phoneNumber Phone Number 1..1 string #xD; emailAddress Email Address 1..1 string #xD; confirmEmailAddress Confirm Email Address 1..1 string #xD; age-check Are you currently between the ages of 28 and 55? 1..1 boolean #xD; birthdate Birthdate 1..1 date #xD; sex Sex 1..1 choice Options: 2 options #xD; height Height (in inches). For HERA missions, height not to exceed 6' 2" (74 inches) 1..1 decimal #xD; weight Weight (in pounds) 1..1 decimal #xD; born-outside-us Were you born outside of the United States? 1..1 boolean #xD; other-citizenship Do you hold citizenship in any country other than the United States? 1..1 boolean #xD; tobacco-nicotine Do you use any tobacco or nicotine products (select all that apply)? 1..* choice Options: 6 options #xD; medical-section Medical History 1..1 group #xD; metal-in-body Do you have any metal in your body other than dental work? 1..1 boolean #xD; claustrophobia Are you claustrophobic? 1..1 boolean #xD; allergies-gi-diet Do you have any of the following? 0..* choice Options: 3 options #xD; cardiovascular Any cardiovascular or circulatory system issues? 1..1 boolean #xD; neurological Any neurological problems? 1..1 boolean #xD; musculoskeletal Any musculoskeletal problems? 1..1 boolean #xD; medications Are you taking any medications? 1..1 boolean #xD; sleep-disorders Any sleep disorders such as sleep walking or use of sleep aids? 1..1 boolean #xD; psychiatric Any psychiatric disorders or history of mental illness? 1..1 boolean #xD; motion-sickness Any motion sickness (not a disqualifier)? 1..1 boolean #xD; adhd-treatment Any pharmacological treatment for ADHD? 1..1 boolean #xD; kidney-stones Any history of kidney stones? 1..1 boolean #xD; ulcers Any history of ulcers? 1..1 boolean #xD; epilepsy Any history of epilepsy or other disorders of the brain? 1..1 boolean #xD; blood-clots Any history of blood clots? 1..1 boolean #xD; family-seizures Any history of close relatives with seizures? 1..1 boolean #xD; bisphosphonate Are you currently on Bis-Phosphonate (for example, Fosamax, Boniva, or Reclast)? 1..1 boolean #xD; seizure-meds Are you currently on any medication that might increase chances of seizures? 1..1 boolean #xD; experience-background Experience and Background 0..1 group #xD; vr-experience Have you ever experienced virtual reality? 1..1 boolean #xD; military-background Do you have a military background? 1..1 boolean #xD; education What is your highest level of education in a STEM related field? 1..1 choice Options: 5 options #xD; employment Employment Status 1..1 choice Options: 5 options #xD; referral-source How did you hear about HERA? 1..1 choice Options: 7 options #xD; additional-info Please provide any additional information you wish us to consider in your application 0..1 text Max Length: 500 #xD; submission-consent Submitting voluntary information constitutes your consent to the use of the information for the stated purpose. By submitting this form, you are providing voluntary consent to use the information submitted for the purpose stated. The final determination for clearance is the responsibility of NASA. You may be provided the opportunity to personally explain, refute, or clarify any information before a final decision is made. 0..1 display #xD; process-info Typically, all applicants will be contacted within 5 to 7 business days following the submission of this application regarding its status. Eligible applicants may then be asked to provide additional screening information such as a professional resume or CV and must pass a federal background check. 0..1 display #xD; Documentation for this format Options Sets Answer options for sex http://hl7.org/fhir/administrative-gender#male ("Male") http://hl7.org/fhir/administrative-gender#female ("Female") Answer options for tobacco-nicotine None Smoking Vaping Chewing Skin Patches Other Answer options for allergies-gi-diet Allergies (including food) GI Disorders Dietary Limitations Answer options for education Bachelor Master of Science PhD Medical Doctor Other Answer options for employment US Civil Servant Government Contractor Military Other Unemployed Answer options for referral-source Professional Organization Recruitment Announcement Conference Social Media Referred by Friend or Colleague Online Search Other
Application for the Human Exploration Research Analog (HERA) mission at NASA Johnson Space Center
To determine eligibility for the Flight Analog Project, including initial screening and evaluation to become a ground study subject.
This information collection meets the requirements of 44 U.S.C 3507. OMB control number 2700-0174, expires 04/30/2026.
Application for Analog Missions. Additional information regarding HERA studies at the Johnson Space Center including a video tour of the HERA facility can be found on the NASA website. Before applying to be a study participant we ask that you review this information for a better understanding of what your participation would entail if chosen as a subject for a future HERA mission.
Privacy Act Statement: Pursuant to the Privacy Act of 1974, 5 U.S.C. § 552a, the following statement is furnished to individuals applying to become ground study subjects for the Flight Analog Project. Authority: This collection is authorized by 51 U.S.C. 20113(a) and 44 U.S.C. 3101. Purpose: We will use the information to determine eligibility for the Flight Analog Project. Effect of Nondisclosure: Supplying the information is voluntary on your part. However, failing to provide all or part of the information may prevent an accurate and timely decision on your application.
By submitting this form, you consent to adding your responses to the analog subject registry. After reviewing your responses, further information may be requested. You may withdraw your information from this registry at any time by sending an e-mail to the recruitment team.
For HERA missions, are you willing to be confined and isolated for required periods of time?
HERA mission duration includes a confined isolation of 45 days. In addition to the isolation phase, each mission includes 16 days of pre-mission data collection and training and 7 days of post-mission data collection, requiring a stay in Houston, TX of up to 72 days.
Are you currently between the ages of 28 and 55?
Height (in inches). For HERA missions, height not to exceed 6' 2" (74 inches)
Were you born outside of the United States?
Do you hold citizenship in any country other than the United States?
Do you use any tobacco or nicotine products (select all that apply)?
Do you have any metal in your body other than dental work?
Any cardiovascular or circulatory system issues?
Any sleep disorders such as sleep walking or use of sleep aids?
Any psychiatric disorders or history of mental illness?
Any motion sickness (not a disqualifier)?
Any history of epilepsy or other disorders of the brain?
Any history of close relatives with seizures?
Are you currently on Bis-Phosphonate (for example, Fosamax, Boniva, or Reclast)?
Are you currently on any medication that might increase chances of seizures?
Have you ever experienced virtual reality?
What is your highest level of education in a STEM related field?
Please provide any additional information you wish us to consider in your application
Submitting voluntary information constitutes your consent to the use of the information for the stated purpose. By submitting this form, you are providing voluntary consent to use the information submitted for the purpose stated. The final determination for clearance is the responsibility of NASA. You may be provided the opportunity to personally explain, refute, or clarify any information before a final decision is made.
Typically, all applicants will be contacted within 5 to 7 business days following the submission of this application regarding its status. Eligible applicants may then be asked to provide additional screening information such as a professional resume or CV and must pass a federal background check.