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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Moderators Guide NHTSA Form 1294	Form	New	Available
Form NHTSA Form 1293 Recruitment Screener	Form	New	Available
Form NHTSA Form 1272 Survey for Seat Belt Safety Public Service Advertising Campaign	Form and Instruction	New	Available
Form NHTSA Form 1271 NHTSA UDDP Comm Checks Moderators Guide	Form and Instruction	New	Available
Form NHTSA Form 1270 NHTSA UDDP Screener	Form	New	Available
Form NHTSA Form 1268 Speed Focus Group Screener	Form	New	Available
Form NHTSA 1269 Speed Focus Group Moderators Guide	Form and Instruction	New	Available
Form NHTSA Form 1262 ODI Focus Group Discsscusison Guide-Attachment B	Form	New	Available
Form NHTSA Form 1261 ODI Focus Group Screener - Attachment A	Form	New	Available
Form NHTSA Form 1256 NHTSA Tween Seat Belt Recruitment Screener - Spanish	Form	New	Available
Form NHTSA Form 1255 NHTSA Tween Seat Belt Recruitment Screener - English	Form	New	Available
Form NHTSA Form 1254 NHTSA Tween Seat Belt Comm Checks Moderators Guide - Spanish	Form	New	Available
Form NHTSA Form 1253 NHTSA Tween Seat Belt Comm Checks Moderators Guide - English	Form	New	Available
Form NHTSA Form 1252 ODI Focus Group Discussion Guide	Form and Instruction	New	Available
Form NHTSA Form 1251 ODI Focus Group Screener	Form	New	Available
Form NHTSA Form 1248 Tagline Assessment Survey	Form and Instruction	New	Available
Form NHTSA Form 1247 Tagline Assessment Screener	Form	New	Available
Form NHTSA Form 1246 Texting Enforcement Screener	Form	New	Available
Form NHTSA Form 1245 Texting Enforcement Moderators Guide	Form	New	Available
Form NHTSA Form 1241 Impaired Driving Online Survey	Form	New	Available
Form NHTSA Form 1214 Parent Discussion Guide-Spanish	Form and Instruction	New	Available
Form NHTSA Form 1213 Parent Screener - Spanish	Form	New	Available
Form NHTSA Form 1211 Tween Discussion Guide	Form and Instruction	New	Available
Form NHTSA Form 1210 Tween Screener	Form	New	Available
Form NHTSA Form 1209 Parent Discussion Guide	Form and Instruction	New	Repair queued
Form NHTSA Form 1208 Parent Screener	Form	New	Available
Form NHTSA Form 1207 Underage DDP Group Discussion Guide	Form and Instruction	New	Available
Form NHTSA Form 1206 Underage DDP Screener Non-High School	Form and Instruction	New	Available
Form NHTSA Form 1205 Underage DDP Screener High School	Form and Instruction	New	Available
Form NHTSA Form 1204 Parents Moderators Guide	Form and Instruction	New	Available
Form NHTSA Form 1203 Parent Screener	Form and Instruction	New	Available
Form NHTSA Form 1202 NVS Tagline & Logo Research Discussion Guide for Qualitative Focus Group	Form and Instruction	New	Available
Form NHTSA Form 1201 NVS Tagline & Logo Research-Participant Screener	Form	New	Available
Form NHTSA Form 1200 Distracted Driving Survey	Form	New	Available
Form NHTSA Form 1194 Moderators Guide Tool Kit Community Participants	Form	New	Available
Form NHTSA Form 1190 Screener Guide for Tool Kit Review Focus Group Community Participants	Form	New	Available
Form NHTSA Form 1193 Moderators Guide Law Enforcement	Form	New	Available
Form NHTSA Form 1189 Screener Guide for Law Enforcement Focus Group Recruitment	Form	New	Available
Form NHTSA Form 1192 Moderators Guide Community Service Delivery Organizations	Form	New	Available
Form NHTSA Form 1188 Screener Guide for Community Service Delivery Organizations Focus Group Recruitment	Form	New	Available
Form NHTSA Form 1191 Moderators Guide-Community Participants	Form	New	Available
Form NHTSA Form 1187 Screener Guide for Community Participants Focus Group Recruitmet	Form	New	Available
Form NHTSA Form 1182 Impaired Driving Survey	Form	New	Available
Form NHTSA Form 1163 Vehicle Safety Hotline (VSH) Customer Service Survey	Form	New	Available
Form NHTSA Form 1180 Usability Screener	Form	New	Available
Form NHTSA Form 1179 Safercar.gov Usability Study	Form and Instruction	New	Available
Form NHTSA Form 1178 NHTSA.gov Usability Study	Form and Instruction	New	Available
Form NHTSA Form 1166 CPS Survey	Form	New	Available
Form NHTSA Form 1165 CIOT 2012 Moderators Guide	Form	New	Repair queued
Form NHTSA Form 1164 CIOT Screener	Form	New	Available
PRA-2127New NHTSA Fast Track Generic Clearance SubmissionTemplate.doc	Supplementary Document	Uploaded 2012-02-21	Available
PRA-2127 NEW NHTSA Fast Track Generic Clearance SS PartB.dot	Supporting Statement B	Uploaded 2012-02-21	Available
PRA-2127 NEW NHTSA Fast Track Generic Clearance Part A.doc	Supporting Statement A	Uploaded 2012-02-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
214664	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	NHTSA Form 1294
214664	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Recruitment Screener
213232	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Survey for Seat Belt Safety Public Service Advertising Campaign
212822	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	NHTSA UDDP Comm Checks Moderators Guide
212822	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	NHTSA UDDP Screener
212640	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Speed Focus Group Screener
212640	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Speed Focus Group Moderators Guide
211926	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	ODI Focus Group Discsscusison Guide-Attachment B
211926	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	ODI Focus Group Screener - Attachment A
211342	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	NHTSA Tween Seat Belt Recruitment Screener - Spanish
211342	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	NHTSA Tween Seat Belt Recruitment Screener - English
211342	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	NHTSA Tween Seat Belt Comm Checks Moderators Guide - Spanish
211342	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	NHTSA Tween Seat Belt Comm Checks Moderators Guide - English
210615	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	ODI Focus Group Discussion Guide
210615	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	ODI Focus Group Screener
210440	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Tagline Assessment Survey
210440	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Tagline Assessment Screener
210143	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Texting Enforcement Screener
210143	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Texting Enforcement Moderators Guide
209615	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Impaired Driving Online Survey
208023	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Parent Discussion Guide-Spanish
208023	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Parent Screener - Spanish
208023	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Tween Discussion Guide
208023	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Tween Screener
208023	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Parent Discussion Guide
208023	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Parent Screener
207809	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Underage DDP Group Discussion Guide
207809	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Underage DDP Screener Non-High School
207809	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Underage DDP Screener High School
207809	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Parents Moderators Guide
207809	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Parent Screener
207339	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	NVS Tagline & Logo Research Discussion Guide for Qualitative Focus Group
207339	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	NVS Tagline & Logo Research-Participant Screener
207106	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Distracted Driving Survey
206016	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Moderators Guide Tool Kit Community Participants
206016	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Screener Guide for Tool Kit Review Focus Group Community Participants
206016	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Moderators Guide Law Enforcement
206016	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Screener Guide for Law Enforcement Focus Group Recruitment
206016	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Moderators Guide Community Service Delivery Organizations
206016	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Screener Guide for Community Service Delivery Organizations Focus Group Recruitment
206016	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Moderators Guide-Community Participants
206016	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Screener Guide for Community Participants Focus Group Recruitmet
205082	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Impaired Driving Survey
204775	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Vehicle Safety Hotline (VSH) Customer Service Survey
204536	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Usability Screener
204536	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Safercar.gov Usability Study
204536	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	NHTSA.gov Usability Study
201751	CPS Tracking	Form	New	CPS Survey
201333	Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	CIOT 2012 Moderators Guide
201333	Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	CIOT Screener

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
Retrieve Notice of Action (NOA)	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

table that charts list comparision

	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

table that charts list of burden

IC Title	Form No.	Form Name
CPS Tracking	NHTSA Form 1166	CPS 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 1268, NHTSA 1269	Speed Focus Group Moderators Guide ,   Speed Focus Group Screener
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
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 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
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 1179, NHTSA Form 1178, NHTSA Form 1180	NHTSA.gov Usability Study ,   Safercar.gov Usability Study ,   Usability Screener
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 1182	Impaired Driving Survey
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 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 1241	Impaired Driving Online Survey
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 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 1272	Survey for Seat Belt Safety Public Service Advertising Campaign
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1163	Vehicle Safety Hotline (VSH) Customer Service Survey
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

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ICR Summary of Burden

table that charts list 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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