Information Collection

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

IC 201333 under ICR 201202-2127-006 · OMB 2127-0682.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2127-0682 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NHTSA Form 1164 Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form
NHTSA Form 1164 CIOT Screener CIOT 2012 screener for OMB review FINAL - 2-27-12.docx	Form
NHTSA Form 1165 CIOT 2012 Moderators Guide CIOT_2012_moderators_guide_for_OMB_review_rev_WC.doc	Form
Dinged_Final.pdf CIOT 2012 - Dinged Storyboard	IC Document
Fakearooney.pdf CIOT 2012 - Fakerooney Storyboard	IC Document
Bobbleheads.pdf CIOT 2012 - Bobbleheads Storyboard	IC Document
It's_Beginning.pdf CIOT 2012 - Its Beginning Storyboard	IC Document
OMB_Clearance_Request_FINAL_-_2-15-12[1].docx CIOT Fast Track Justification	IC Document

IC Title:

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
Form	NHTSA Form 1164	CIOT Screener	CIOT 2012 screener for OMB review FINAL - 2-27-12.docx		No		Paper Only
Form	NHTSA Form 1165	CIOT 2012 Moderators Guide	CIOT_2012_moderators_guide_for_OMB_review_rev_WC.doc		No		Paper Only

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 96

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	96	96
Annual IC Time Burden (Hours)	106	106
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CIOT 2012 - Dinged Storyboard	Dinged_Final.pdf	02/27/2012
CIOT 2012 - Fakerooney Storyboard	Fakearooney.pdf	02/27/2012
CIOT 2012 - Bobbleheads Storyboard	Bobbleheads.pdf	02/27/2012
CIOT 2012 - Its Beginning Storyboard	It's_Beginning.pdf	02/27/2012
CIOT Fast Track Justification	OMB_Clearance_Request_FINAL_-_2-15-12[1].docx	02/27/2012

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