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

Forms and Documents

Document	Type	Status	Availability
Form NHTSA Form 1435 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Repair queued
Form NHTSA Form 1429 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Available
Form NHTSA Form 1357 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Available
Form NHTSA Form 1437 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Available
Form NHTSA Form 1431 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Available
Form NHTSA Form 1433 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Available
Form NHTSA Form 1413 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Repair queued
Form NHTSA Form 1410 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Repair queued
Form NHTSA Form 1406 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Available
Form NHTSA Form 1403 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Available
Form NHTSA Form 1390 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Available
Form NHTSA Form 1393 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Available
Form NHTSA Form 1388 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Available
Form NHTSA Form 1384 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Repair queued
Form NHTSA Form 1383 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Repair queued
Form NHTSA Form 1380 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Repair queued
Form NHTSA Form 1367 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Available
Form NHTSA Form 1335 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Available
Form NHTSA Form 1363 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Available
Form NHTSA Form 1360 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Repair queued
Form NHTSA Form 1358 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Available
Form NHTSA Form 1356 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Available
Form NHTSA Form 1349 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Available
Form NHTSA Form 1341 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Repair queued
Form NHTSA Form 1335 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Available
Form NHTSA Form 1213 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Available
Form NHTSA Form 1308 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Available
Form NHTSA Form 1272 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Repair queued
Form NHTSA Form 1305 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Available
Form NHTSA Form 1301 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Available
Form NHTSA Form 1298 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Available
Form NHTSA Form 1298 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Available
Form NHTSA Form 1271 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Available
Form NHTSA Form 1297 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Available
PRA-2127-0682_NHTSA_Fast_Track_Generic_Clearance_SubmissionTemplate[1].doc	Supplementary Document	Uploaded 2015-02-12	Repair queued
PRA-2127-0682_NHTSA Fast Track Clearance Part B.docx	Supporting Statement B	Uploaded 2015-02-12	Available
PRA-2127_0682_NHTSA_Fast_Track_Generic_Clearance_Part_A.doc	Supporting Statement A	Uploaded 2015-02-12	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
231071	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
230896	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
230829	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
230746	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
230313	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New
230186	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New
228552	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery		New
227982	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
227881	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
227083	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
227059	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
226876	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
226309	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New
225174	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
224936	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
224676	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
224448	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New
224002	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
223349	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
223109	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
222345	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
222017	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
221720	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Other-Evaluation Comment Card	New
221493	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New
220546	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
220502	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
220114	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
218738	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
218619	OMB Aquisition 360 Review	Instruction	New
217969	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
217766	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
217469	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New
217145	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New
216844	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
216653	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New
216160	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New
215955	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New

ICR Details

OMB Control No: 2127-0682	ICR Reference No: 201502-2127-002
Status: Historical Active	Previous ICR Reference No: 201202-2127-006
Agency/Subagency: DOT/NHTSA	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/02/2015
	Date Received in OIRA: 02/26/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2018	36 Months From Approved	04/30/2015
Responses	113,582	0	113,582
Time Burden (Hours)	20,204	0	20,204
Cost Burden (Dollars)	135,820	0	135,820

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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:
	79 FR 72243	12/05/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 8941	02/19/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 37

IC Title	Form No.	Form Name
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1381, NHTSA Form 1379, NHTSA Form 1380	Speed Moderators Guide A ,   Speed MOderators Guide B ,   Speed Screener
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1335, NHTSA Form 1336	Buzz Driving Screener ,   Moderators Guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1300, NHTSA Form 1301	Moderator's Guide Parent and Caretaker Focus Groups to Develop Childhood Passenger Safety Public Service Advertising Campaign ,   Recruitment Screener Parent and Caretaker Focus Groups to Develop Child Passenger Safety Public Service Advertising Campaign
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1272	Survey for Child Passenger Safety
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1298	Ladders of Opportunity: Transportation Youth Initiative
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1357	GMSS Training Evaluation
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1362, NHTSA Form 1361, NHTSA Form 1360	Recruitment SCreener for Focus Groups: Students ,   Recruitment Screener for Focus Groups: Night Shift Workers ,   Moderator’s Guide for Focus Groups
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1364, NHTSA Form 1363	Drugged Driver Recruitment Screener ,   Drugged Driving Moderators Guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1393, NHTSA Form 1394	Parents of Teen Drivers Moderators Guide ,   Parents of Teen Drivers Screener
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1305, NHTSA Form 1306, NHTSA Form 1307	Bulletin Board Guide Redesign ,   Bulletin Board Screener - General ,   Bulletin Board Screener - Female
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1367, NHTSA Form 1368	Recruitment Screener for Focus Groups ,   Moderator's Guide for Fcous Groups
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1383	DBE Questionnaire
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1388, NHTSA Form 1389	Recruitment Screener ,   Moderators Guide
OMB Aquisition 360 Review
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1358, NHTSA Form 1359	Recruitment Screener ,   Moderator's guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1349	Mayors Challenge for Safer People and Safer Streets Survey
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1434, NHTSA Form 1433	CIOT Recruitment Screener ,   CIOT Moderators Guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1429, NHTSA Form 1430	Advanced Safety Nomenclature Screener ,   Advanced Safety Nomenclature Discussion Guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1308	Survey for Underage Drinking and Driving Prevention Public Service Advertising Campaign
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1213, NHTSA Form 1313	Recruitment Screener - Branding Positioning ,   Moderators Guide - Branding Positioning
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1341, NHTSA Form 1342	Recruitment Screener ,   Moderator's Guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1271, NHTSA Form 1270	NHTSA UDDP Comm Checks Moderators Guide ,   NHTSA UDDP Screener
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1297, NHTSA Form 1298	Recruitment Screener ,   Moderators Guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1411, NHTSA Form 1412, NHTSA Form 1410	NHTSA Autonomus Vehicles Focus Group Screener ,   NHTSA Autonomus Vehicles Discussion Guide ,   Autonomus Driving Workbook
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1335, NHTSA Form 1336	Buzzed Driving Screener ,   Buzzed Driving Moderators Guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1407, NHTSA Form 1406	Drugged Driver Recruitment Sceener ,   Drugged Driving Mod Guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1403, NHTSA Form 1405, NHTSA Form 1404	Informed Consent ,   Motorcycle Recruitment Screener ,   Motorcycle Focus Group Moderators Guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1438, NHTSA Form 1437	CIOT Screener Spanish-Reliant ,   CIOT Moderators Guide Spanish-Reliant
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1298, NHTSA Form 1299	Child Passenger Safety Recruit Screener ,   Child Passenger Safety Moderators Guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1384	Online Survey Questionnaire - Impaired Driving Public Service Advertising Campaign
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1356, NHTSA Form 1355	Drugged Driving Moderators Guide ,   Drugged Driver Screener
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1413, NHTSA Form 1414	Drunk Driver Concepts Screener ,   Drunk Driving Moderators Guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1390	Distracted Driving Tracking Study
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1432, NHTSA Form 1431	Recruitment Screener - Parent and Caretaker ,   Child Passenger Safety Discussion Guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1436, NHTSA Form 1435	UDDP Screener ,   UDDP Moderators Guide

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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	113,582	0	0	0	0
Annual Time Burden (Hours)	20,204	20,204	0	0	0	0
Annual Cost Burden (Dollars)	135,820	135,820	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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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: 02/26/2015

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