Information Collection

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

IC 235440 under ICR 201804-2127-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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 1485 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Form
NHTSA Form 1485 Drug Impaired Drving Survey Drug Impaired Driving_ Survey Instrument_3.13.19 Final.docx	Form
Fast Track Clearance Request_Drug Impaired Driving_ OnlineSurvey_2.25.19....docx Fast Track Request	IC Document
Drug-Impaired Creative for OMB Submission.pdf Drug Impaired Creative	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 1485	Drug Impaired Drving Survey	Drug Impaired Driving_ Survey Instrument_3.13.19 Final.docx		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

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	1,000	1,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track Request	Fast Track Clearance Request_Drug Impaired Driving_ OnlineSurvey_2.25.19....docx	03/22/2019
Drug Impaired Creative	Drug-Impaired Creative for OMB Submission.pdf	03/22/2019

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