NHTSA_CCS_2019 Communications Checks

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2127-0682 can be found here:

Documents and Forms

Document Name Document Type
Form NHTSA Form 1436 NHTSA_CCS_2019 Communications Checks Form
NHTSA Form 1306 Online Study Screener NHTSA_CCS_2019_Communication Checks Screener_061219 (002).docx Form
NHTSA Form 1436 Online Survey Questions NHTSA_CCS_2019_Communication Checks Questionnaire_061219 (002).docx Form
NHTSA_CCS_2019_Communications Checks Generic Clearance_062419.docx NHTSA_CCS_2019_Communication Checks Generic Clearance IC Document
AdCouncilNHTSA_6.12.19.pdf AdCouncil IC Document

Information Collection (IC) Details

IC Title:	NHTSA_CCS_2019 Communications Checks	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NHTSA Form 1436	Online Survey Questions	NHTSA_CCS_2019_Communication Checks Questionnaire_061219 (002).docx		Yes	Yes	Fillable Fileable
Form	NHTSA Form 1306	Online Study Screener	NHTSA_CCS_2019_Communication Checks Screener_061219 (002).docx		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
NHTSA_CCS_2019_Communication Checks Generic Clearance	NHTSA_CCS_2019_Communications Checks Generic Clearance_062419.docx	07/02/2019
AdCouncil	AdCouncilNHTSA_6.12.19.pdf	07/02/2019

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