Information Collection

Parents are the Key Teen Driving Safety Initiative

IC 212361 under ICR 201111-0920-003 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Parents are the Key Teen Driving Safety Initiative	Form and Instruction
Pediatrician Screener Attachment N - Pediatrician Screener - Screenshots.pdf	Form and Instruction
Parent Message Testing Moderator's Guide Attachment I - Parent Message Testing (Moderator) Guide - Screenshots.pdf	Form and Instruction
Parent Message Testing Moderator's Guide - Spanish Attachment J - Parent Message Testing (Moderator) Guide - Spanish - Screenshots.pdf	Form and Instruction
Pediatrician Message Testing Moderator's Guide Attachment K - Pediatrician Message Testing (Moderator) Guide - Screenshots.pdf	Form and Instruction
Parent Screener Attachment L - Parent Screener - Screenshot 7-22-14.pdf	Form and Instruction
Parent Screener - Spanish Attachment M - Parent Screener - Spanish Version - Screenshot 7-22-14.pdf	Form and Instruction
Attachment A - Project Description.docx Project Description	IC Document
Attachment B - Burden Table.docx Burden Table	IC Document
Attachment E - Pediatrician Screener.docx Pediatrician Screener - word	IC Document
Attachment F - Parents Message Testing (Moderator) Guide.docx Parent Message Testing Moderator's Guide - word	IC Document
Attachment G - Parents Message Testing (Moderator) Guide - Spanish Version.docx Parent Message Testing Moderator's Guide - Spanish - word	IC Document
Attachment H - Pediatricians Message Testing (Moderator) Guide.docx Pediatrician Message Testing Moderator's Guide - word	IC Document
Attachment O - Parents Emails.docx Parent email	IC Document
Attachment P - Parents Emails - Spanish Version.docx Parent email - Spanish	IC Document
Attachment Q - Pediatricians Emails.docx Pediatrician email	IC Document
HMTS Expedited Review Form.pdf Expedited Review Form	IC Document
Attachment C - Parent Screener_CLEAN 7-22-14.docx Parent Screener	IC Document
Attachment D - Parent Screener - Spanish Version_CLEAN 7-22-14.docx Parent Screener - Spanish	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Parents are the Key Teen Driving Safety Initiative

Agency IC Tracking Number:

14 VV

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	Pediatrician Screener	Attachment N - Pediatrician Screener - Screenshots.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	none	Parent Message Testing Moderator's Guide	Attachment I - Parent Message Testing (Moderator) Guide - Screenshots.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	none	Parent Message Testing Moderator's Guide - Spanish	Attachment J - Parent Message Testing (Moderator) Guide - Spanish - Screenshots.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	none	Pediatrician Message Testing Moderator's Guide	Attachment K - Pediatrician Message Testing (Moderator) Guide - Screenshots.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	none	Parent Screener	Attachment L - Parent Screener - Screenshot 7-22-14.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	none	Parent Screener - Spanish	Attachment M - Parent Screener - Spanish Version - Screenshot 7-22-14.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 174

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	174	174
Annual IC Time Burden (Hours)	119	119
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Project Description	Attachment A - Project Description.docx	07/16/2014
Burden Table	Attachment B - Burden Table.docx	07/16/2014
Pediatrician Screener - word	Attachment E - Pediatrician Screener.docx	07/16/2014
Parent Message Testing Moderator's Guide - word	Attachment F - Parents Message Testing (Moderator) Guide.docx	07/16/2014
Parent Message Testing Moderator's Guide - Spanish - word	Attachment G - Parents Message Testing (Moderator) Guide - Spanish Version.docx	07/16/2014
Pediatrician Message Testing Moderator's Guide - word	Attachment H - Pediatricians Message Testing (Moderator) Guide.docx	07/16/2014
Parent email	Attachment O - Parents Emails.docx	07/16/2014
Parent email - Spanish	Attachment P - Parents Emails - Spanish Version.docx	07/16/2014
Pediatrician email	Attachment Q - Pediatricians Emails.docx	07/16/2014
Expedited Review Form	HMTS Expedited Review Form.pdf	07/16/2014
Parent Screener	Attachment C - Parent Screener_CLEAN 7-22-14.docx	07/28/2014
Parent Screener - Spanish	Attachment D - Parent Screener - Spanish Version_CLEAN 7-22-14.docx	07/28/2014

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