Information Collection

Parents are the Key Teen Driving Safety Initiative

IC 212361 under ICR 201501-0920-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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: Unchanged

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
	Requested	Previously Approved
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.