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 NHTSA Form 1436 UDDP Moderators Guide	Form and Instruction	New	Available
Form NHTSA Form 1435 UDDP Screener	Form	New	Available
Form NHTSA Form 1430 Advanced Safety Nomenclature Discussion Guide	Form and Instruction	New	Available
Form NHTSA Form 1429 Advanced Safety Nomenclature Screener	Form	New	Available
Form NHTSA Form 1357 GMSS Training Evaluation	Form	New	Available
Form NHTSA Form 1438 CIOT Moderators Guide Spanish-Reliant	Form and Instruction	New	Available
Form NHTSA Form 1437 CIOT Screener Spanish-Reliant	Form	New	Available
Form NHTSA Form 1432 Child Passenger Safety Discussion Guide	Form and Instruction	New	Available
Form NHTSA Form 1431 Recruitment Screener - Parent and Caretaker	Form and Instruction	New	Available
Form NHTSA Form 1434 CIOT Moderators Guide	Form and Instruction	New	Available
Form NHTSA Form 1433 CIOT Recruitment Screener	Form and Instruction	New	Available
Form NHTSA Form 1414 Drunk Driving Moderators Guide	Form and Instruction	New	Available
Form NHTSA Form 1413 Drunk Driver Concepts Screener	Form	New	Available
Form NHTSA Form 1412 Autonomus Driving Workbook	Form	New	Available
Form NHTSA Form 1411 NHTSA Autonomus Vehicles Discussion Guide	Form and Instruction	New	Available
Form NHTSA Form 1410 NHTSA Autonomus Vehicles Focus Group Screener	Form	New	Available
Form NHTSA Form 1407 Drugged Driving Mod Guide	Form and Instruction	New	Available
Form NHTSA Form 1406 Drugged Driver Recruitment Sceener	Form	New	Available
Form NHTSA Form 1405 Motorcycle Focus Group Moderators Guide	Form and Instruction	New	Available
Form NHTSA Form 1404 Motorcycle Recruitment Screener	Form	New	Available
Form NHTSA Form 1403 Informed Consent	Form	New	Available
Form NHTSA Form 1390 Distracted Driving Tracking Study	Form	New	Available
Form NHTSA Form 1394 Parents of Teen Drivers Screener	Form	New	Available
Form NHTSA Form 1393 Parents of Teen Drivers Moderators Guide	Form and Instruction	New	Available
Form NHTSA Form 1389 Moderators Guide	Form and Instruction	New	Available
Form NHTSA Form 1388 Recruitment Screener	Form	New	Available
Form NHTSA Form 1384 Online Survey Questionnaire - Impaired Driving Public Service Advertising Campaign	Form	New	Available
Form NHTSA Form 1383 DBE Questionnaire	Form	New	Available
Form NHTSA Form 1379 Speed Screener	Form	New	Available
Form NHTSA Form 1381 Speed MOderators Guide B	Form and Instruction	New	Available
Form NHTSA Form 1380 Speed Moderators Guide A	Form and Instruction	New	Available
Form NHTSA Form 1368 Moderator's Guide for Fcous Groups	Form and Instruction	New	Available
Form NHTSA Form 1367 Recruitment Screener for Focus Groups	Form	New	Available
Form NHTSA Form 1336 Moderators Guide	Form	New	Available
Form NHTSA Form 1335 Buzz Driving Screener	Form	New	Available
Form NHTSA Form 1364 Drugged Driving Moderators Guide	Form	New	Available
Form NHTSA Form 1363 Drugged Driver Recruitment Screener	Form	New	Available
Form NHTSA Form 1362 Moderator’s Guide for Focus Groups	Form	New	Available
Form NHTSA Form 1361 Recruitment Screener for Focus Groups: Night Shift Workers	Form	New	Available
Form NHTSA Form 1360 Recruitment SCreener for Focus Groups: Students	Form	New	Available
Form NHTSA Form 1359 Moderator's guide	Form and Instruction	New	Available
Form NHTSA Form 1358 Recruitment Screener	Form	New	Available
Form NHTSA Form 1355 Drugged Driver Screener	Form and Instruction	New	Available
Form NHTSA Form 1356 Drugged Driving Moderators Guide	Form and Instruction	New	Available
Form NHTSA Form 1349 Mayors Challenge for Safer People and Safer Streets Survey	Form	New	Available
Form NHTSA Form 1342 Moderator's Guide	Form	New	Available
Form NHTSA Form 1341 Recruitment Screener	Form	New	Available
Form NHTSA Form 1336 Buzzed Driving Moderators Guide	Form and Instruction	New	Available
Form NHTSA Form 1335 Buzzed Driving Screener	Form	New	Available
Form NHTSA Form 1313 Moderators Guide - Branding Positioning	Form and Instruction	New	Available
Form NHTSA Form 1213 Recruitment Screener - Branding Positioning	Form	New	Available
Form NHTSA Form 1308 Survey for Underage Drinking and Driving Prevention Public Service Advertising Campaign	Form	New	Available
Form NHTSA Form 1272 Survey for Child Passenger Safety	Form	New	Available
Form NHTSA Form 1307 Bulletin Board Screener - Female	Form	New	Available
Form NHTSA Form 1306 Bulletin Board Screener - General	Form	New	Available
Form NHTSA Form 1305 Bulletin Board Guide Redesign	Form and Instruction	New	Available
Form NHTSA Form 1300 Recruitment Screener Parent and Caretaker Focus Groups to Develop Child Passenger Safety Public Service Advertising Campaign	Form	New	Available
Form NHTSA Form 1301 Moderator's Guide Parent and Caretaker Focus Groups to Develop Childhood Passenger Safety Public Service Advertising Campaign	Form and Instruction	New	Available
Form NHTSA Form 1298 Ladders of Opportunity: Transportation Youth Initiative	Form	New	Available
Form NHTSA Form 1299 Child Passenger Safety Moderators Guide	Form and Instruction	New	Available
Form NHTSA Form 1298 Child Passenger Safety Recruit Screener	Form	New	Available
Form NHTSA Form 1270 NHTSA UDDP Screener	Form	New	Available
Form NHTSA Form 1271 NHTSA UDDP Comm Checks Moderators Guide	Form and Instruction	New	Available
Form NHTSA Form 1298 Moderators Guide	Form	New	Available
Form NHTSA Form 1297 Recruitment Screener	Form	New	Available
PRA-2127-0682_NHTSA_Fast_Track_Generic_Clearance_SubmissionTemplate[1].doc	Supplementary Document	Uploaded 2015-02-12	Available
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

Information collection document groups

IC ID	Collection	Type	Status	Form
231071	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	UDDP Moderators Guide
231071	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	UDDP Screener
230896	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Advanced Safety Nomenclature Discussion Guide
230896	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Advanced Safety Nomenclature Screener
230829	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	GMSS Training Evaluation
230746	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	CIOT Moderators Guide Spanish-Reliant
230746	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	CIOT Screener Spanish-Reliant
230313	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Child Passenger Safety Discussion Guide
230313	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Recruitment Screener - Parent and Caretaker
230186	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	CIOT Moderators Guide
230186	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	CIOT Recruitment Screener
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 and Instruction	New	Drunk Driving Moderators Guide
227982	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Drunk Driver Concepts Screener
227881	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Autonomus Driving Workbook
227881	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	NHTSA Autonomus Vehicles Discussion Guide
227881	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	NHTSA Autonomus Vehicles Focus Group Screener
227083	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Drugged Driving Mod Guide
227083	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Drugged Driver Recruitment Sceener
227059	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Motorcycle Focus Group Moderators Guide
227059	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Motorcycle Recruitment Screener
227059	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Informed Consent
226876	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Distracted Driving Tracking Study
226309	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Parents of Teen Drivers Screener
226309	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Parents of Teen Drivers Moderators Guide
225174	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Moderators Guide
225174	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Recruitment Screener
224936	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Online Survey Questionnaire - Impaired Driving Public Service Advertising Campaign
224676	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	DBE Questionnaire
224448	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Speed Screener
224448	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Speed MOderators Guide B
224448	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Speed Moderators Guide A
224002	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Moderator's Guide for Fcous Groups
224002	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Recruitment Screener for Focus Groups
223349	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Moderators Guide
223349	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Buzz Driving Screener
223109	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Drugged Driving Moderators Guide
223109	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Drugged Driver Recruitment Screener
222345	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Moderator’s Guide for Focus Groups
222345	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Recruitment Screener for Focus Groups: Night Shift Workers
222345	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Recruitment SCreener for Focus Groups: Students
222017	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Moderator's guide
222017	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Recruitment Screener
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	Drugged Driver Screener
221493	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Drugged Driving Moderators Guide
220546	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Mayors Challenge for Safer People and Safer Streets Survey
220502	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Moderator's Guide
220502	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Recruitment Screener
220114	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Buzzed Driving Moderators Guide
220114	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Buzzed Driving Screener
218738	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Moderators Guide - Branding Positioning
218738	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Recruitment Screener - Branding Positioning
218619	OMB Aquisition 360 Review	Instruction	New
217969	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Survey for Underage Drinking and Driving Prevention Public Service Advertising Campaign
217766	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Survey for Child Passenger Safety
217469	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Bulletin Board Screener - Female
217469	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Bulletin Board Screener - General
217469	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Bulletin Board Guide Redesign
217145	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Recruitment Screener Parent and Caretaker Focus Groups to Develop Child Passenger Safety Public Service Advertising Campaign
217145	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Moderator's Guide Parent and Caretaker Focus Groups to Develop Childhood Passenger Safety Public Service Advertising Campaign
216844	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Ladders of Opportunity: Transportation Youth Initiative
216653	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	Child Passenger Safety Moderators Guide
216653	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Child Passenger Safety Recruit Screener
216160	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	NHTSA UDDP Screener
216160	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction	New	NHTSA UDDP Comm Checks Moderators Guide
215955	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Moderators Guide
215955	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form	New	Recruitment Screener

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
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/26/2015
Terms of Clearance:

table that charts list comparision

	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

table that charts list of burden

IC Title	Form No.	Form Name
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	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 1308	Survey for Underage Drinking and Driving Prevention Public Service Advertising Campaign
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 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 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 1349	Mayors Challenge for Safer People and Safer Streets Survey
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 1341, NHTSA Form 1342	Recruitment Screener ,   Moderator's Guide
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 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 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 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
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 1436, NHTSA Form 1435	UDDP Screener ,   UDDP Moderators Guide
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 1383	DBE Questionnaire
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 1384	Online Survey Questionnaire - Impaired Driving Public Service Advertising Campaign
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 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 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 1297, NHTSA Form 1298	Recruitment Screener ,   Moderators Guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	NHTSA Form 1388, NHTSA Form 1389	Recruitment Screener ,   Moderators 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 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 1357	GMSS Training Evaluation
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 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 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 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 1335, NHTSA Form 1336	Buzz Driving Screener ,   Moderators Guide
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 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 1390	Distracted Driving Tracking Study
OMB Aquisition 360 Review

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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	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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