Information Collection

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

IC 206312 under ICR 201109-2125-001 · OMB 2125-0628.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2125-0628 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
IntersectionSafety_State_Survey_Questions_032713.pdf	Other-Web Survey
fast-track-PRA-submission-short-form_FHWA-Intersection-Safety-Survey_021413[1].doc FHWA Intersection Safety Program Customer Satisfaction Survey	IC Document

IC Title:

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Web Survey			IntersectionSafety_State_Survey_Questions_032713.pdf		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 28

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	28	28
Annual IC Time Burden (Hours)	14	14
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
FHWA Intersection Safety Program Customer Satisfaction Survey	fast-track-PRA-submission-short-form_FHWA-Intersection-Safety-Survey_021413[1].doc	03/29/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.