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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form NHTSA Form 1241 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Form
NHTSA Form 1241 Impaired Driving Online Survey Impaired Driving Online Survey Instrument_120613 (2).doc Form
Fast Track Clearance Request_Impaired Driving_ OnlineSurvey_112013.docx Fast Track Request_Impaired Driving_Online Survey IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC 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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NHTSA Form 1241	Impaired Driving Online Survey	Impaired Driving Online Survey Instrument_120613 (2).doc		No		Fillable Printable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast Track Request_Impaired Driving_Online Survey	Fast Track Clearance Request_Impaired Driving_ OnlineSurvey_112013.docx	12/09/2013

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