Information Collection

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

IC 220114 under ICR 201502-2127-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 1335 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form
NHTSA Form 1335 Buzzed Driving Screener BUZZED DRIVING SCREENING REVISED_020316_FINAL.docx	Form
NHTSA Form 1336 Buzzed Driving Moderators Guide BUZZED DRIVING MODERATORS GUIDE_020316_FINAL.docx	Form and Instruction
NHTSA Buzzed Fast Track Clearance Request_021216.docx Fast Track Clearance Request	IC Document

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:

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 1335	Buzzed Driving Screener	BUZZED DRIVING SCREENING REVISED_020316_FINAL.docx		Yes	Yes	Fillable Fileable
Form and Instruction	NHTSA Form 1336	Buzzed Driving Moderators Guide	BUZZED DRIVING MODERATORS GUIDE_020316_FINAL.docx		No		Paper Only

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 72

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	72	72
Annual IC Time Burden (Hours)	93	93
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track Clearance Request	NHTSA Buzzed Fast Track Clearance Request_021216.docx	02/16/2016

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