> ![](media/image1.wmf){width="0.8in"
> height="0.7in"}![](media/image2.wmf){width="0.525in"
> height="0.5729166666666666in"}

<table>
<colgroup>
<col style="width: 6%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 5%" />
<col style="width: 1%" />
<col style="width: 10%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 8%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 5%" />
<col style="width: 8%" />
<col style="width: 0%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="2">Executive</td>
<td colspan="22"></td>
</tr>
<tr class="even">
<td>Title</td>
<td colspan="23"></td>
</tr>
<tr class="odd">
<td colspan="2">Organization</td>
<td colspan="9"></td>
<td colspan="2">Installation</td>
<td colspan="11"></td>
</tr>
<tr class="even">
<td colspan="3">Performance Period:</td>
<td colspan="3">Oct 1,</td>
<td colspan="3">2006</td>
<td>to Sept 30,</td>
<td colspan="2">2007</td>
<td colspan="3">If other, from</td>
<td colspan="4"></td>
<td colspan="2">to</td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="4"></td>
<td colspan="2"></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="24"><strong>Performance Plan Development</strong></td>
</tr>
<tr class="odd">
<td colspan="24">Performance criteria for the above period have been
established and provided to the Executive.</td>
</tr>
<tr class="even">
<td colspan="3">Executive Signature</td>
<td colspan="15"></td>
<td colspan="3">Date:</td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="8">Supervisory Official Name and Signature</td>
<td colspan="10"></td>
<td colspan="3">Date:</td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="5"></td>
<td colspan="2"></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="24"><strong>Progress Review</strong></td>
</tr>
<tr class="even">
<td colspan="24">A minimum of one review must be conducted within 30
days of March 31. If performance requirements have changed, the plan
should be modified accordingly.</td>
</tr>
<tr class="odd">
<td colspan="24">A Progress Review has been conducted by Executive and
Supervisory Official.</td>
</tr>
<tr class="even">
<td colspan="3">Executive Signature</td>
<td colspan="15"></td>
<td colspan="3">Date:</td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="8">Supervisory Official Signature</td>
<td colspan="9"></td>
<td colspan="3">Date:</td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td colspan="15"></td>
<td colspan="3"></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="24"><strong>Performance Appraisal - Initial Summary Rating.
Rating is not final until reviewed by the Performance Review Board and
approved by the Administrator.</strong></td>
</tr>
<tr class="even">
<td colspan="24"><p>RATING LEVEL (Rating must be fully justified in the
narrative summary.)</p>
<p> UNSATISFACTORY MINIMALLY FULLY HIGHLY OUTSTANDING</p>
<p>SATISFACTORY SUCCESSFUL SUCCESSFUL</p></td>
</tr>
<tr class="odd">
<td colspan="7">Supervisory Official Signature</td>
<td colspan="11"></td>
<td colspan="3">Date:</td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="24">EXECUTIVE RESPONSE/REQUEST FOR REVIEW</td>
</tr>
<tr class="odd">
<td colspan="24"> I do not wish to provide a written response and/or
request a higher-level review.</td>
</tr>
<tr class="even">
<td colspan="24"><p>W I wish to provide a written response. (Complete
Appendix A.) Response must be submitted within 10 days of receipt of
Initial</p>
<p>Summary Rating.</p></td>
</tr>
<tr class="odd">
<td colspan="24"> I wish to request a higher-level review. (Complete
Appendix A.)</td>
</tr>
<tr class="even">
<td colspan="3">Executive Signature</td>
<td colspan="15"></td>
<td colspan="3">Date:</td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="3"></td>
<td colspan="15"></td>
<td colspan="3"></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="24"><strong>Management and Performance Review Board/Senior
Executive Committee Reviews</strong></td>
</tr>
<tr class="odd">
<td colspan="24">Complete the following, or complete Appendix A, if the
executive has provided a written response or requested a higher-level
review, or the Executive Position Manager or the Performance Review
Board/Senior Executive Committee recommend an alternate Summary Rating
Level.</td>
</tr>
<tr class="even">
<td colspan="24">EXECUTIVE POSITION MANAGER:</td>
</tr>
<tr class="odd">
<td colspan="24">I concur with the Initial Summary Rating.</td>
</tr>
<tr class="even">
<td colspan="4">Name and Signature</td>
<td colspan="14"></td>
<td colspan="3">Date:</td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="24">PERFORMANCE REVIEW BOARD/SENIOR EXECUTIVE
COMMITTEE:</td>
</tr>
<tr class="even">
<td colspan="24">We concur with and recommend the Initial Summary Rating
to the NASA Administrator or Designee.</td>
</tr>
<tr class="odd">
<td colspan="5">Signature of Official Designee</td>
<td colspan="13"></td>
<td colspan="3">Date:</td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="24">NASA ADMINISTRATOR OR DESIGNEE:</td>
</tr>
<tr class="odd">
<td colspan="16">The Initial Summary Rating is approved and designated
as the Annual Performance Summary Rating.</td>
<td colspan="6">Date Approved:</td>
<td colspan="2"></td>
</tr>
</tbody>
</table>

**NASA FORM 1701 Dec 06** PAGE 1

**Senior Executive Service Performance Planning and Appraisal**

+-----------------------------------------------------------------------+
| **[OVERVIEW]{.underline}** -- The NASA Performance Management System  |
| for the Senior Executive Service (SES) encourages excellence in       |
| performance, facilitates the accurate evaluation of performance based |
| on performance results, provides for the systematic appraisal of      |
| performance, and provides a basis for pay, awards, development,       |
| retention, removal, and other personnel decisions. The system         |
| promotes the achievement of the Agency's goals and a commitment to    |
| the core values by expecting and encouraging managerial excellence in |
| individual and organizational performance and holding executives      |
| accountable for results. The system focuses on improved communication |
| and goal clarity and provides for participative performance planning, |
| setting, and communicating individual and organizational goals and    |
| performance requirements that are linked to strategic planning        |
| initiatives and the Agency's Annual Performance Plan, continual       |
| performance monitoring to assess achievements, and annual appraisals  |
| of performance using measures that balance individual and             |
| organizational results with customer, employee, and stake holder      |
| perspectives. Active participation of the senior executive with the   |
| supervisor in the total performance appraisal process is important to |
| the overall system effectiveness.                                     |
|                                                                       |
| **[PERFORMANCE PLANNING]{.underline}** -- The supervisor, in          |
| consultation with the senior executive, defines Performance           |
| Requirements for the appraisal period and documents them in the       |
| senior executive's performance plan. Each plan will include a         |
| Program/Project/Functional Objective(s) element specific to the       |
| position and a standard Management Competencies element as described  |
| on page 4. Performance Requirements are to be written at the "Fully   |
| Successful" level.                                                    |
|                                                                       |
| **[Program/Project/Functional Objective]{.underline}:** This          |
| objective is the critical element that holds an Executive accountable |
| for achieving business results. Business results should be the goals  |
| established in the Agency's current Fiscal Year Performance Plan.     |
|                                                                       |
| [Mission-Related Position]{.underline} -- To ensure alignment, the    |
| program/project objective [must]{.underline} identify at least one    |
| specific Annual Performance Goal(s) (APGs) from the Agency's current  |
| Fiscal Year Performance Plan as a [results-focused]{.underline}       |
| critical element. This objective should be an APG(s) for which the    |
| Executive is responsible and/or to which he/she will contribute and   |
| of such importance that unsatisfactory performance in this element    |
| would result in an overall performance summary rating of              |
| unsatisfactory. Next, the specific Agency Objective(s) and Outcome(s) |
| associated with the APG(s) must be identified. This will establish    |
| alignment and clear linkage to the Agency's Mission, strategic goals, |
| and annual performance plan and budget priorities.                    |
|                                                                       |
| [Mission Support Position]{.underline} -- The functional objective    |
| [must]{.underline} identify at least one specific goal(s) within the  |
| Executive's functional area of responsibility as a                    |
| [results-focused]{.underline} critical element that will enable the   |
| Mission Directorates and Centers to accomplish their APGs.            |
| Consideration should be given to the Agency-specific goals identified |
| relative to the Governmentwide initiatives of the President's         |
| Management Agenda (PMA) to improve management and program             |
| performance. This objective should be a goal for which the Executive  |
| is responsible and/or to which he/she will contribute and of such     |
| importance that unsatisfactory performance in this element would      |
| result in an overall performance summary rating of unsatisfactory.    |
| Next, an Agency-specific goal(s) and/or external commitment(s)        |
| associated with the Executive's goal must be identified. This will    |
| establish alignment and clear linkage to the Agency's Mission,        |
| strategic goals, and annual performance plan and budget priorities.   |
|                                                                       |
| If the Executive is a manager or supervisor, the work objectives of   |
| his/her subordinates should be linked to the specific Agency          |
| Objective(s), Outcome(s), and APG(s)/goal(s) identified.              |
|                                                                       |
| **[Performance Requirements for Program/Project/Functional            |
| Objective]{.underline}:** Performance requirements should be          |
| described in terms of specific result(s), with metrics, that the      |
| Executive must accomplish in order for the Agency to achieve the      |
| APG(s). Performance requirements should not be described as           |
| activities but as expected results in terms of clear, credible        |
| measures (e.g., quality, quantity, timeliness and/or                  |
| cost-effectiveness) of performance. They should be Specific,          |
| Measurable, and Aggressive yet Achievable, Results oriented and Time  |
| based (SMART).                                                        |
|                                                                       |
| [Mission-Related Position]{.underline} -- For each APG, identify the  |
| performance requirements (e.g., Efficiency Measure(s) if applicable)  |
| that support the achievement of the Program/Project Objective and     |
| Outcome that has been identified. Additional performance requirements |
| related to the Agency's programmatic metrics, generated by programs   |
| and projects, should be identified as appropriate.                    |
|                                                                       |
| [Mission Support Position]{.underline} -- For each goal, identify the |
| performance requirements that support the achievement of the Agency   |
| Objective and Outcome that has been identified. Institutional metrics |
| relating to the Agency's administration, facilities, human capital,   |
| and other elements that fall outside the purview of programs and      |
| projects should be identified, as appropriate, as performance         |
| requirements in addition to any external metrics derived from the     |
| PMA.                                                                  |
|                                                                       |
| If the Executive is a manager or supervisor, the performance          |
| requirements or expectations of his/her subordinates should be linked |
| to and support the achievement of the Executive's performance         |
| requirements.                                                         |
|                                                                       |
| **[PROGRESS REVIEW]{.underline}** -- At a minimum, one progress       |
| review must be conducted between March 1 and April 30. The plan       |
| should be signed and dated to document the midterm review. If the     |
| performance plan is changed, the changes should be documented in the  |
| plan.                                                                 |
|                                                                       |
| **[PERFORMANCE ASSESSMENT]{.underline}** -- At the end of the         |
| appraisal period, the immediate supervisor and the senior executive   |
| discuss the actual individual and organization achievements during    |
| the appraisal period. Performance is assessed by the supervisor based |
| on individual and organizational performance taking into account such |
| factors as APG's or goals achieved, the effectiveness, productivity,  |
| and performance of assigned employees, meeting safety and diversity   |
| goals and complying with merit system principles. Customer, employee  |
| and other stake holder perspectives will be considered in this        |
| assessment.                                                           |
|                                                                       |
| **[PERFORMANCE ELEMENT/SUMMARY RATING LEVEL                           |
| DEFINITIONS]{.underline}**                                            |
|                                                                       |
| Element 1 will receive a relative weight of 60%; Element 2 will       |
| receive a relative weight of 40%. The weight factor times the Element |
| Rating will determine the Summary Rating. The maximum weighted score  |
| is 5.0.                                                               |
|                                                                       |
| OUTSTANDING: *Element Rating* -- Performance exceeds requirements to  |
| an exceptional degree. *Summary Rating* -- Total performance in the   |
| position exceeds requirements to an exceptional degree; weighted      |
| score is 4.6 or above.                                                |
|                                                                       |
| HIGHLY SUCCESSFUL: *Element Rating* -- Performance exceeds            |
| requirements to a substantial degree. *Summary Rating* -- Total       |
| performance in the position exceeds requirements to a substantial     |
| degree; no element is rated below "Fully Successful;" weighted score  |
| is 4.0-4.5.                                                           |
|                                                                       |
| FULLY SUCCESSFUL - *Element Rating* *--* Performance fully meets      |
| requirements. *Summary Rating* -- Total performance in the position   |
| fully meets requirements; both elements are rated "Fully Successful"  |
| or higher; weighted score is 3.0-3.9.                                 |
|                                                                       |
| MINIMALLY SATISFACTORY - *Element Rating* -- Performance only         |
| partially meets requirements. *Summary Rating* -- Total performance   |
| in the position only partially meets requirements; one or more        |
| elements is rated "Minimally Satisfactory" and no element is rated    |
| "Unsatisfactory."                                                     |
|                                                                       |
| UNSATISFACTORY - *Element Ratin*g -- Performance does not meet        |
| requirements. *Summary Rating* -- Total performance in the position   |
| does not meet requirements; when any element is rated                 |
| \"Unsatisfactory.\"                                                   |
|                                                                       |
| Outstanding: 4.6-5.0 Minimally Satisfactory: Any Element rated        |
| Minimally Satisfactory, with none rated Unsatisfactory:               |
|                                                                       |
| Highly Successful: 4.0-4.5 Unsatisfactory: Any Element rated          |
| Unsatisfactory:                                                       |
|                                                                       |
| Fully successful: 3.0-3.9                                             |
+-----------------------------------------------------------------------+

**NASA FORM 1701 Dec** **06** PAGE 2

  ----------- -------------------------- ------ ------------ ---- --------------
  Executive                              From   Oct. 1, 2006 To   Sept. 30, 2007

  ----------- -------------------------- ------ ------------ ---- --------------

![](media/image1.wmf){width="0.8in"
height="0.7in"}![](media/image2.wmf){width="0.525in"
height="0.5729166666666666in"}

+-----------------------------------------------------------------------+
| A Critical Element is a key component of an executive's work that     |
| contributes to organizational goals and results and is so important   |
| that unsatisfactory performance of it would make the executive's      |
| overall job performance unsatisfactory. *(See previous page for       |
| Performance Summary Rating Level Definitions.)* **[NOTE: Text is      |
| limited to the space provided below.]{.underline}**                   |
+-----------------------------------------------------------------------+
| **1. Program/Project/Functional Objectives**                          |
+-----------------------------------------------------------------------+
| **Agency Objective(s) and Outcome(s) or Agency-specific goal(s)       |
| and/or external commitment(s) to which this element aligns (State     |
| specific objective(s), outcome(s), goal(s), or commitment(s) and cite |
| source, e.g., Annual Performance Plan, PMA, etc.)**                   |
+-----------------------------------------------------------------------+
| **PERFORMANCE REQUIREMENT FOR FULLY SUCCESSFUL**                      |
+-----------------------------------------------------------------------+
| **PROGRAM/PROJECT/FUNCTIONAL RATING** *(Any rating other than "Fully  |
| Successful" must be justified specifically in the narrative           |
| summary.)*                                                            |
|                                                                       |
| UNSATISFACTORY MINIMALLY FULLY HIGHLY OUTSTANDING                     |
|                                                                       |
| SATISFACTORY SUCCESSFUL SUCCESSFUL                                    |
+-----------------------------------------------------------------------+

**NASA FORM 1701 Dec 06** PAGE 3

**2. [Management Competencies]{.underline}:** Management competencies
are directly related to the SES Executive Core Qualifications (ECQs).

**[Performance Requirements]{.underline}:** In rare cases, not all of
the performance requirements for each competency may be applicable to an
executive's position. Such performance requirements should be identified
during the performance planning stage with the explanation that it is
not applicable to the Executive's position in the block for Performance
Requirement.

**a. Leading and Managing Change *[Performance
Requirements]{.underline}:***

-   The impact of changing national priorities on the Agency's Mission,
    strategic goals and objectives, performance requirements, programs,
    and projects is clearly articulated as a vision for the organization
    and effectively communicated to capture the commitment of the
    workforce.

-   To achieve the vision, strategies are developed to redefine programs
    and projects and associated performance requirements and outcomes as
    needed.

-   The implementation of the resulting changes to the organization and
    workforce are accomplished with minimal disruption.

-   Risk taking, creative thinking, and innovation to identify new work
    processes to meet performance requirements and to effect change are
    supported and encouraged.

    **b. Leading and Managing People** ***[Performance
    Requirements]{.underline}:***

```{=html}
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```
-   An inclusive work environment exists where employees are valued and
    respected for their individual and cultural differences, treat one
    another fairly and with respect, and their talents are utilized,
    regardless of background.

-   Cooperation, collaboration, and teamwork across NASA Centers and
    functions are actively promoted in the accomplishment of the
    targeted performance requirements and outcomes.

-   The work environment encourages the open and honest exchange of
    information and the expression of ideas, diverse opinions, and
    dissenting views while presenting one voice to the public.

-   Conflicts are resolved in a positive and constructive manner.

-   A work environment exists that recognizes and supports the needs of
    employees to balance work and personal life.

**(Supervisory Only)**

-   Performance plans and appraisals of subordinate staff members are
    completed by the due date; and at least one critical element for
    each is clearly traceable to the Agency's goals and objectives
    (e.g., as appropriate, the Strategic Plan, Agency Performance Plan,
    PMA initiatives, etc.).

-   Performance plans and appraisals of the employees reporting to
    subordinate managers and supervisors within the executive's
    organization are completed by the due date; and at least one
    critical element for each is clearly traceable to the Agency's goals
    and objectives.

-   Feedback on performance is provided to subordinate staff members on
    a frequent basis; their performance and that of their employees, as
    an individual or as a member of a team, is recognized with
    performance awards that are commensurate with the level of
    performance, responsibility, and progress towards the goals and
    objectives; the distribution of annual performance awards mirrors
    the distribution of performance ratings. Appropriate and timely
    action is taken to address performance that does not meet
    expectations.

-   Employees are provided opportunities to excel and encouraged to
    expand their knowledge and skills through coaching, mentoring,
    developmental assignments, and training.

-   The performance of subordinate staff members is appraised fairly
    against Specific, Measurable, Aggressive yet Achievable,
    Results-oriented and Time-based (SMART) performance expectations.

    **c. Achieving Results *[Performance Requirements]{.underline}:***

```{=html}
<!-- -->
```
-   In the pursuit of the accomplishment of the Agency's goals and
    objectives, the behaviors exhibited exemplify a commitment to NASA's
    core values of safety, teamwork, integrity, and mission success.

-   Short- and long-term organizational goals and objectives are based
    on the Agency's Strategic Plan and Governmentwide initiatives and
    are realistic, measurable, and results-oriented.

-   Work units are organized with the appropriate technical expertise
    and balance of workload to ensure organizational priorities are
    achieved.

-   Potential or actual problems relating to the achievement of
    program/project objectives are identified and diagnosed with
    alternative courses of action identified and brought to the
    attention of the appropriate management officials in a timely
    manner.

-   Performance results and customer feedback are used to develop and
    implement initiatives to improve program/project performance,
    functional support, or service delivery.

    **d. Resources Management *[Performance
    Requirements]{.underline}:***

```{=html}
<!-- -->
```
-   Workforce or project teams are deployed to accomplish efficiently
    and effectively the organization's goals and objectives.

-   Current and future workforce or project team needs are assessed
    based on the organization's goals and objectives.

-   Program/project/functional budgets are well-defined and defensible
    and prepared within external and internal guidelines and by due
    dates.

-   Programs/projects/functions are managed cost-effectively including
    contractor costs; any unutilized funds or cost overruns are
    identified and brought immediately to the attention of senior
    management.

-   Program/project/functional and contractor performance are reviewed
    periodically to monitor progress against milestones and goals; any
    problems or schedule delays are identified and immediately brought
    to the attention of senior management.

-   Information technology is utilized effectively to organize and
    manage work and resources and to track and assess progress.

**(Supervisory Only)**

-   To address skills imbalances and succession needs, highly qualified
    candidates are hired; developed; and promoted ensuring adherence to
    the Merit Systems Principles and equal opportunity without regard to
    race, color, national origin, sex, sexual orientation, or religion
    and by providing, if needed, reasonable accommodation(s) to an
    otherwise qualified individual with a disability utilizing all
    available hiring flexibilities.

    **e. Communications and Teamwork *[Performance
    Requirements]{.underline}:***

-   Oral and written presentations are effective (e.g., accurate, well
    organized, and easily understood).

-   Information, results and decisions are communicated in a timely
    manner.

-   Interactions with others demonstrate the ability to listen
    effectively and to seek the opinions, ideas, and expertise of
    others.

-   Working relationships, both internal and external, are cooperative
    and demonstrate the ability to be flexible and adaptable,
    facilitating win-win situations and the open exchange of ideas and
    opinions from diverse groups.

-   Interactions with others demonstrate respect and an understanding of
    others' needs; establish trust; and foster support, cooperation, and
    knowledge sharing for the accomplishment of the Agency's goals and
    objectives.

+-----------------------------------------------------------------------+
| **PERFORMANCE REQUIREMENT FOR FULLY SUCCESSFUL** *(Note any deviation |
| from above.)*                                                         |
+-----------------------------------------------------------------------+
| **MANAGEMENT COMPETENCIES RATING** (Any rating other than "Fully      |
| Successful" must be justified specifically in the narrative summary.) |
|                                                                       |
| UNSATISFACTORY MINIMALLY FULLY HIGHLY OUTSTANDING                     |
|                                                                       |
| SATISFACTORY SUCCESSFUL SUCCESSFUL                                    |
+-----------------------------------------------------------------------+

**NASA FORM 1701 Dec 06** PAGE 4

  ----------- ------------------------- ------ ------------ ---- --------------
  Executive                             From   Oct 1, 2006  To   Sept 30, 2007

  ----------- ------------------------- ------ ------------ ---- --------------

![](media/image1.wmf){width="0.8in"
height="0.7in"}![](media/image2.wmf){width="0.525in"
height="0.5729166666666666in"}

  -----------------------------------------------------------------------
  Describe specific achievements, results and behaviors justifying
  executive's performance rating against program/project/functional
  objectives and management competencies. **[NOTE: Text is limited to the
  space provided below.]{.underline}**

  **PROGRAM/PROJECT/FUNCTIONAL OBJECTIVES**

  **MANAGEMENT COMPETENCIES**
  -----------------------------------------------------------------------

**NASA FORM 1701 Dec 06** PAGE 5

<table style="width:100%;">
<colgroup>
<col style="width: 9%" />
<col style="width: 5%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 5%" />
<col style="width: 9%" />
<col style="width: 11%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 6%" />
<col style="width: 2%" />
<col style="width: 4%" />
<col style="width: 13%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="6"><p><img src="media/image1.wmf"
style="width:0.8in;height:0.7in" /><img src="media/image2.wmf"
style="width:0.525in;height:0.57292in" /></p>
<table>
<colgroup>
<col style="width: 3%" />
<col style="width: 42%" />
<col style="width: 53%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="2">Executive
______________________________________________________</td>
<td></td>
</tr>
<tr class="even">
<td>Title</td>
<td colspan="2"></td>
</tr>
</tbody>
</table>
<p>For the Performance Appraisal Period:</p></td>
<td colspan="2">From</td>
<td colspan="5"></td>
<td>To</td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td colspan="6"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="20"><strong>Incumbent Executive</strong></td>
</tr>
<tr class="even">
<td colspan="20">Check One or Both:</td>
</tr>
<tr class="odd">
<td colspan="20"> I am submitting a written response to my Initial
Summary Rating. Response must be submitted within 10 days of receipt of
Initial Summary Rating.</td>
</tr>
<tr class="even">
<td colspan="20"> I am requesting a higher-level review of my Initial
Summary Rating.</td>
</tr>
<tr class="odd">
<td>Signature</td>
<td colspan="16"></td>
<td colspan="2">Date:</td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td colspan="6"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="20"><strong>Higher-Level Review - If more than one
Higher-Level Review, attach additional Appendix A's.</strong></td>
</tr>
<tr class="even">
<td colspan="2">Reviewer's Name:</td>
<td colspan="18"></td>
</tr>
<tr class="odd">
<td colspan="2">Reviewer's Title:</td>
<td colspan="18"></td>
</tr>
<tr class="even">
<td colspan="20"><blockquote>
<p>I have reviewed the Performance Appraisal, the Initial Summary
Rating, and any written response submitted by the Executive.</p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="20"><blockquote>
<p>Check One:</p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="20"> I concur with the Initial Summary Rating.</td>
</tr>
<tr class="odd">
<td colspan="15"> I do not concur with the Initial Summary Rating;
therefore, I recommend a rating of</td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td colspan="20">(Attach a written explanation; provide a copy to all
principals.)</td>
</tr>
<tr class="odd">
<td>Signature</td>
<td colspan="16"></td>
<td colspan="2">Date:</td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td colspan="6"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="20"><strong>Performance Review Board/Senior Executive
Committee Review</strong></td>
</tr>
<tr class="even">
<td colspan="20">Review of Executive's Written Response: Reviewed No
written response submitted</td>
</tr>
<tr class="odd">
<td colspan="20"><p>Review of any higher-level review(s): Concur with
recommendations Do not concur. (Attach a written explanation;</p>
<p>provide a copy to all principals.)</p></td>
</tr>
<tr class="even">
<td colspan="20">Review of Initial Summary Rating: Concur with the
recommended Initial Summary Rating.</td>
</tr>
<tr class="odd">
<td colspan="16"> Do not concur; therefore, we recommend a rating
of</td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td colspan="20">(Attach a written explanation; provide a copy to all
principals.)</td>
</tr>
<tr class="odd">
<td colspan="4">Signature of Official Designee:</td>
<td colspan="13"></td>
<td colspan="2">Date:</td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td colspan="6"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="20"><strong>NASA Administrator or Designee</strong></td>
</tr>
<tr class="even">
<td colspan="20">In determining the Annual Performance Summary Rating, I
have reviewed the Performance Appraisal; the Initial Summary Rating; any
written response submitted by the Executive, the Higher-Level
Official(s), and the Performance Review Board or the Senior Executive
Committee Reviews; and the recommendation of the Performance Review
Board or the Senior Executive Committee.</td>
</tr>
<tr class="odd">
<td colspan="5"></td>
<td colspan="12"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="20"> I concur with the Performance Review Board/Senior
Executive Committee review and recommendation and approve the
recommended Summary Rating as the Annual Performance Summary
Rating.</td>
</tr>
<tr class="odd">
<td colspan="20"> I do not concur with the Performance Review
Board/Senior Executive Committee review and recommendation; therefore, I
assign</td>
</tr>
<tr class="even">
<td colspan="9"><blockquote>
<p>an Annual Performance Summary Rating of</p>
</blockquote></td>
<td colspan="11"></td>
</tr>
<tr class="odd">
<td colspan="20"></td>
</tr>
<tr class="even">
<td>Signature</td>
<td colspan="16"></td>
<td colspan="2">Date:</td>
<td></td>
</tr>
</tbody>
</table>

**NASA FORM 1701A Dec 06 Appendix A**