Information Collection

Assessment of Characteristics of State Crash Outcome Data Evaluation Systems: Focus Groups

IC 206223 under ICR 201110-0920-004 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Assessment of Characteristics of State Crash Outcome Data Evaluation Systems: Focus Groups	Form and Instruction
Att E - Focus Group Scheduling Email Attachment E- Intro Email.docx	Form and Instruction
Att G - Screenshots of Doodle Poll Attachment G- Doodle Poll (Web).docx	Form
Att H - Focus Group Script Attachment H- FS script.docx	Form and Instruction
CODES-FS- Supporting Statement A.docx Supporting Statement A	IC Document
CODES-FS- Supporting Statement B.docx Supporting Statement B	IC Document
Attachment A- Traffic Safety Facts.pdf Att A - Traffic Safety Facts	IC Document
Attachment B - Winnable Battle.pdf Att B - Frieden Letter	IC Document
Attachment C- List of States.docx Att C - Invited States	IC Document
Attachment D - Assessment results.pdf Att D - Assessment Findings	IC Document
Attachment I - FS presentation.pptx Att I - Slides for Focus Group	IC Document
Attachment J- Email Reminder.docx Att J - Email to Participants	IC Document
Attachment F- Doodle Poll (Word).docx Att F - Doodle Poll - Word	IC Document

IC Title:

Assessment of Characteristics of State Crash Outcome Data Evaluation Systems: Focus Groups

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Att E - Focus Group Scheduling Email	Attachment E- Intro Email.docx	Yes	Yes	Fillable Fileable
Form	none	Att G - Screenshots of Doodle Poll	Attachment G- Doodle Poll (Web).docx	Yes	Yes	Fillable Fileable
Form and Instruction	none	Att H - Focus Group Script	Attachment H- FS script.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 116

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 New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	116	0	0	0	0	0
Annual IC Time Burden (Hours)	189	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	CODES-FS- Supporting Statement A.docx	03/21/2013
Supporting Statement B	CODES-FS- Supporting Statement B.docx	03/21/2013
Att A - Traffic Safety Facts	Attachment A- Traffic Safety Facts.pdf	03/21/2013
Att B - Frieden Letter	Attachment B - Winnable Battle.pdf	03/21/2013
Att C - Invited States	Attachment C- List of States.docx	03/21/2013
Att D - Assessment Findings	Attachment D - Assessment results.pdf	03/21/2013
Att I - Slides for Focus Group	Attachment I - FS presentation.pptx	03/21/2013
Att J - Email to Participants	Attachment J- Email Reminder.docx	03/21/2013
Att F - Doodle Poll - Word	Attachment F- Doodle Poll (Word).docx	03/21/2013

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