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

Forms and Documents

Document Name	Status
Form NHTSA Form 1293 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
Form NHTSA Form 1272 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form and Instruction	New
Form NHTSA Form 1270 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
Form NHTSA 1269 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form and Instruction	New
Form NHTSA Form 1261 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
Form NHTSA Form 1253 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
Form NHTSA Form 1251 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
Form NHTSA Form 1247 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
Form NHTSA Form 1245 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
Form NHTSA Form 1241 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
Form NHTSA Form 1208 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
Form NHTSA Form 1203 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form and Instruction	New
Form NHTSA Form 1201 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
Form NHTSA Form 1200 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
Form NHTSA Form 1187 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
Form NHTSA Form 1182 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
Form NHTSA Form 1163 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
Form NHTSA Form 1178 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form and Instruction	New
Form NHTSA Form 1166 CPS Tracking Form	New
Form NHTSA Form 1164 Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
PRA-2127New NHTSA Fast Track Generic Clearance SubmissionTemplate.doc Supplementary Document	2012-02-21
PRA-2127 NEW NHTSA Fast Track Generic Clearance SS PartB.dot Supporting Statement B	2012-02-21
PRA-2127 NEW NHTSA Fast Track Generic Clearance Part A.doc Supporting Statement A	2012-02-21

IC Document Collections

IC ID	Document Title	Status
214664	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
213232	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form and Instruction	New
212822	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
212640	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form and Instruction	New
211926	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
211342	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
210615	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
210440	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
210143	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
209615	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
208023	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
207809	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form and Instruction	New
207339	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
207106	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
206016	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
205082	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
204775	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New
204536	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form and Instruction	New
201751	CPS Tracking Form	New
201333	Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form	New

ICR Details

OMB Control No: 2127-0682	ICR Reference No: 201202-2127-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOT/NHTSA	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/21/2012
	Date Received in OIRA: 02/21/2012
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2015	36 Months From Approved
Responses	113,582	0	0
Time Burden (Hours)	20,204	0	0
Cost Burden (Dollars)	135,820	0	0

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Abstract: This collection of information is necessary to enable the Agency to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the Agency's programs.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 80542	12/22/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 62148	10/06/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 20

IC Title	Form No.	Form Name
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1182	Impaired Driving Survey
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1204, NHTSA Form 1205, NHTSA Form 1206, NHTSA Form 1207, NHTSA Form 1203	Parent Screener ,   Parents Moderators Guide ,   Underage DDP Screener High School ,   Underage DDP Screener Non-High School ,   Underage DDP Group Discussion Guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1214, NHTSA Form 1208, NHTSA Form 1209, NHTSA Form 1210, NHTSA Form 1211, NHTSA Form 1213	Parent Screener ,   Parent Discussion Guide ,   Tween Screener ,   Tween Discussion Guide ,   Parent Screener - Spanish ,   Parent Discussion Guide-Spanish
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1164, NHTSA Form 1165	CIOT Screener ,   CIOT 2012 Moderators Guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1255, NHTSA Form 1256, NHTSA Form 1254, NHTSA Form 1253	NHTSA Tween Seat Belt Comm Checks Moderators Guide - English ,   NHTSA Tween Seat Belt Comm Checks Moderators Guide - Spanish ,   NHTSA Tween Seat Belt Recruitment Screener - English ,   NHTSA Tween Seat Belt Recruitment Screener - Spanish
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1245, NHTSA Form 1246	Texting Enforcement Moderators Guide ,   Texting Enforcement Screener
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1241	Impaired Driving Online Survey
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1200	Distracted Driving Survey
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1261, NHTSA Form 1262	ODI Focus Group Screener - Attachment A ,   ODI Focus Group Discsscusison Guide-Attachment B
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1248, NHTSA Form 1247	Tagline Assessment Screener ,   Tagline Assessment Survey
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1187, NHTSA Form 1191, NHTSA Form 1188, NHTSA Form 1192, NHTSA Form 1189, NHTSA Form 1193, NHTSA Form 1190, NHTSA Form 1194	Screener Guide for Community Participants Focus Group Recruitmet ,   Moderators Guide-Community Participants ,   Screener Guide for Community Service Delivery Organizations Focus Group Recruitment ,   Moderators Guide Community Service Delivery Organizations ,   Screener Guide for Law Enforcement Focus Group Recruitment ,   Moderators Guide Law Enforcement ,   Screener Guide for Tool Kit Review Focus Group Community Participants ,   Moderators Guide Tool Kit Community Participants
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1271, NHTSA Form 1270	NHTSA UDDP Screener ,   NHTSA UDDP Comm Checks Moderators Guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1272	Survey for Seat Belt Safety Public Service Advertising Campaign
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1251, NHTSA Form 1252	ODI Focus Group Screener ,   ODI Focus Group Discussion Guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1163	Vehicle Safety Hotline (VSH) Customer Service Survey
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1268, NHTSA 1269	Speed Focus Group Moderators Guide ,   Speed Focus Group Screener
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Moderators Guide, NHTSA Form 1293	Recruitment Screener ,   NHTSA Form 1294
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1201, NHTSA Form 1202	NVS Tagline & Logo Research-Participant Screener ,   NVS Tagline & Logo Research Discussion Guide for Qualitative Focus Group
CPS Tracking	NHTSA Form 1166	CPS Survey
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1179, NHTSA Form 1178, NHTSA Form 1180	NHTSA.gov Usability Study ,   Safercar.gov Usability Study ,   Usability Screener

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	113,582	0	0	113,582	0	0
Annual Time Burden (Hours)	20,204	0	0	20,204	0	0
Annual Cost Burden (Dollars)	135,820	0	0	135,820	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This collection of information is necessary to enable the Agency to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the Agency's programs.

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Annual Cost to Federal Government: $205,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/21/2012

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