Information Collection

Transportation and Health Tool Website User Satisfaction Assessment

IC 222775 under ICR 201510-0923-001 · OMB 0923-0047.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0047 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Transportation and Health Tool Website User Satisfaction Assessment	Form
A4_THT RcruitmntEmlTlphnIntrvwUsbltyTstrs.docx	Instruction
A5_THT UsrStsfctnTlphneIntrvw.docx	Other-Telephone Interview
A1_THTRcrtmntEmlOnlneUsrStsfcnSurvey.docx	Instruction
User Satisfaction Survey A2_THT Online UsrStsfctnSrvy.docx	Form
User Satisfaction Survey - screenshots A3_THT OnlneSrvyScrnshts.pdf	Form
0923-0047 NCEH-ATSDR CustomerFeedback_THTUserSatisfactionAsses.pdf Request for Approval	IC Document

IC Title:

Transportation and Health Tool Website User Satisfaction Assessment

Agency IC Tracking Number:

16AWD

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	User Satisfaction Survey	A2_THT Online UsrStsfctnSrvy.docx	Yes	Yes	Fillable Fileable
Form	none	User Satisfaction Survey - screenshots	A3_THT OnlneSrvyScrnshts.pdf	Yes	Yes	Fillable Fileable
Instruction			A4_THT RcruitmntEmlTlphnIntrvwUsbltyTstrs.docx	Yes	Yes	Fillable Fileable
Other-Telephone Interview			A5_THT UsrStsfctnTlphneIntrvw.docx	Yes	No	Paper Only
Instruction			A1_THTRcrtmntEmlOnlneUsrStsfcnSurvey.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 450

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	450	450
Annual IC Time Burden (Hours)	78	78
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	0923-0047 NCEH-ATSDR CustomerFeedback_THTUserSatisfactionAsses.pdf	08/01/2016

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