Information Collection

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

IC 221493 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⚠️ Notice: This information collection may be referencing outdated material.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 1356 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form and Instruction
NHTSA Form 1356 Drugged Driving Moderators Guide Drugged Driving mod guide 050316_FINAL.doc	Form and Instruction
NHTSA Form 1355 Drugged Driver Screener Drugged Driving Screener 050316_FINAL.docx	Form and Instruction
Drugged Driving Generic Clearance 042616_FINAL.docx Drugged Driving Generic Clearance	IC Document
Stoned Face.jpg Stoned Face	IC Document
Not Moving.jpg Not Moving	IC Document
Joint and Wheel.jpg Joint and Wheel	IC Document
Fuzzy Dash.jpg Fuzzy Dash	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 and Instruction	NHTSA Form 1356	Drugged Driving Moderators Guide	Drugged Driving mod guide 050316_FINAL.doc		No		Paper Only
Form and Instruction	NHTSA Form 1355	Drugged Driver Screener	Drugged Driving Screener 050316_FINAL.docx		No		Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 180

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	198	198
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Drugged Driving Generic Clearance	Drugged Driving Generic Clearance 042616_FINAL.docx	05/12/2016
Stoned Face	Stoned Face.jpg	05/12/2016
Not Moving	Not Moving.jpg	05/12/2016
Joint and Wheel	Joint and Wheel.jpg	05/12/2016
Fuzzy Dash	Fuzzy Dash.jpg	05/12/2016

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