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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NHTSA Form 1336 Awareness Campaign to Reduce Distracted Driving - Moderators Guide	Form	New	Repair queued
Form NHTSA Form 1666 Awareness Campaign to Reduce Distracted Driving - Screener	Form	New	Repair queued
Form NHTSA Form 1665 2022 ODI Recall Creative Testing Research - Discussion Guide	Form and Instruction	New	Repair queued
Form NHTSA Form 1664 2022 ODI Recall Creative Testing Research - Screener	Form	New	Repair queued
Form NHTSA Form 1653 Marijuana Impairment Exploratory Research - Spanish Discussion Guide	Form and Instruction	New	Repair queued
Form NHTSA Form 1651 Marijuana Impairment Exploratory Research - Spanish Screener	Form	New	Repair queued
Form NHTSA Form 1652 Marijuana Impairment Exploratory Research - Discussion Guide	Form and Instruction	New	Repair queued
Form NHTSA Form 1650 Marijuana Impairment Exploratory Reseach - English Screener	Form	New	Repair queued
Form NHTSA Form 1661 Rear Seat Belt Creative Testing Research - Discussion Guide	Form and Instruction	New	Repair queued
Form NHTSA Form 1660 Rear Seat Bealt Creative Testing Research - Screener	Form	New	Repair queued
Form NHTSA Form 1658 Speeding Enforcement Concept Assessment Research - Spanish Translation	Form	New	Repair queued
Form NHTSA Form 1657 Speeding Enforcement Concept Assessment Reasrch - Spanish Discussion Guide	Form and Instruction	New	Repair queued
Form NHTSA Form 1656 Speeding Enforcement Concept Assessment Research - Spanish Screener	Form	New	Repair queued
Form NHTSA Form 1655 Speeding Enforcement Concept Assessment Researcg - Discussion Guide	Form and Instruction	New	Repair queued
Form NHTSA Form 1654 Speed Enforcement Concept Assessment Research - English Screener	Form	New	Repair queued
Form NHTSA Form 1658 Speed Prevention Social Norming Concept Assessment Research Online Focus Group - Spanish Translation	Form	New	Repair queued
Form NHTSA Form 1657 Speed Prevention Social Norming Concept Assessment Research Online Focus Groups - Discussion Guide Spanish	Form and Instruction	New	Repair queued
Form NHTSA Form 1656 Speed Prevention Social Norming Concept Assessment Reseacrh Online Focus Group - Spanish Screener	Form	New	Repair queued
Form NHTSA Form 1655 Speed Prevention Social Norming Concept Assessment Reseacrh Online Focus Groups - Discussion Guide	Form and Instruction	New	Repair queued
Form NHTSA Form 1654 Speed Prevention Social Norming Concept Assessment Research Online Focus Groups - Recruitment Screener - English	Form	New	Repair queued
Form NHTSA Form 1646 Rail Grade Crossing Creative Testing - Spanish Screeer Translation	Form	New	Repair queued
Form NHTSA Form 1645 Rail Grade Crossing Creative Testing - Spanish Screener	Form	New	Repair queued
Form NHTSA Form 1644 Rail Grade Crossing Creative Testing - Discussion Guide Spanish	Form and Instruction	New	Repair queued
Form NHTSA Form 1643 Rail Grade Crossing Creative Testing - English Screener	Form	New	Repair queued
Form NHTSA Form 1642 Rail Grade Crossing Creative Testing - Discussion Guide English	Form and Instruction	New	Repair queued
Form NHTSA Form 1641 Speed Prevention - Spanish Discussion Guide	Form and Instruction	New	Repair queued
Form NHTSA Form 1640 Speed Prevention - English Discussion Guide	Form and Instruction	New	Repair queued
Form NHTSA Form 1639 Speed Prevention - Spanish Screener	Form	New	Repair queued
Form NHTSA Form 1638 Speed Prevention - Spanish Screener - English Translation	Form	New	Repair queued
Form NHTSA Form 1637 Speed Prevention - English Screener	Form	New	Repair queued
Form NHTSA Form 1634 CIOT Discussion Guide - Spanish	Form and Instruction	New	Repair queued
Form NHTSA Form 1633 CIOT Discussion Guide - English	Form and Instruction	New	Repair queued
Form NHTSA Form 1632 CIOT Screener - Spanish	Form	New	Repair queued
Form NHTSA Form 1631 CIOT Screener - English	Form	New	Repair queued
Form SBIR - 001 SBIR Awardee Satisfaction	Form and Instruction	New	Available
Form AAHM Small Busines AAHM Small Business Outreach Questions	Form	New	Repair queued
Form 1472 Screener Guide	Form	Unchanged	Available
Form DBE Survey Questio DBE Survey Questions	Form and Instruction	Unchanged	Available
Form Voluntary Web-Base Voluntary Web-Based Inventory of Airport Concession Disadvantaged Business Enterprises and Disadvantaged Business Enterprise Firms	Form and Instruction	Unchanged	Repair queued
Supporting_Statement_OST_Generic_Clearance_June_2019_Updated.docx	Supporting Statement A	Uploaded 2019-06-20	Available
30-day_Notice_for_2105-0573_OST_Fast_Track_Generic_Clearance_84.FR.26177_on_20190605.pdf	Supplementary Document	Uploaded 2019-06-06	Available
2105_0573_Fast_Track_Generic_Clearance_60-Day_Notice_84_FR_11866_March_28_2019.pdf	Supplementary Document	Uploaded 2019-06-06	Available
Justification for change - Removing a generic clearance ICR from the inventory.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2018-11-28	Repair queued
Supporting_Statement_Part_B_Acquisition_360_Nov_2016.doc	Supporting Statement B	Uploaded 2016-11-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
254385	Awareness Campaign to Reduce Distracted Driving	Form	New	Awareness Campaign to Reduce Distracted Driving - Moderators Guide
254385	Awareness Campaign to Reduce Distracted Driving	Form	New	Awareness Campaign to Reduce Distracted Driving - Screener
254027	GENERIC CLEARANCE FOR THE COLLECTION OF QUALITATIVE FEEDBACK ON AD CONCEPTS FOR OFFICE OF DEFECTS INVESTIGATION VEHICLE RECALLS CAMPAIGN PROMOTION	Form and Instruction	New	2022 ODI Recall Creative Testing Research - Discussion Guide
254027	GENERIC CLEARANCE FOR THE COLLECTION OF QUALITATIVE FEEDBACK ON AD CONCEPTS FOR OFFICE OF DEFECTS INVESTIGATION VEHICLE RECALLS CAMPAIGN PROMOTION	Form	New	2022 ODI Recall Creative Testing Research - Screener
252987	MARIJUANA IMPAIRMENT EXPLORATORY RESEARCH ONLINE FOCUS GROUPS	Form and Instruction	New	Marijuana Impairment Exploratory Research - Spanish Discussion Guide
252987	MARIJUANA IMPAIRMENT EXPLORATORY RESEARCH ONLINE FOCUS GROUPS	Form	New	Marijuana Impairment Exploratory Research - Spanish Screener
252987	MARIJUANA IMPAIRMENT EXPLORATORY RESEARCH ONLINE FOCUS GROUPS	Form and Instruction	New	Marijuana Impairment Exploratory Research - Discussion Guide
252987	MARIJUANA IMPAIRMENT EXPLORATORY RESEARCH ONLINE FOCUS GROUPS	Form	New	Marijuana Impairment Exploratory Reseach - English Screener
252903	REAR SEAT BELT CREATIVE TESTING RESEARCH ONLINE FOCUS GROUPS	Form and Instruction	New	Rear Seat Belt Creative Testing Research - Discussion Guide
252903	REAR SEAT BELT CREATIVE TESTING RESEARCH ONLINE FOCUS GROUPS	Form	New	Rear Seat Bealt Creative Testing Research - Screener
252601	SPEED PREVENTION ENFORCEMENT CONCEPT ASSESSMENT RESEARCH ONLINE FOCUS GROUPS	Form	New	Speeding Enforcement Concept Assessment Research - Spanish Translation
252601	SPEED PREVENTION ENFORCEMENT CONCEPT ASSESSMENT RESEARCH ONLINE FOCUS GROUPS	Form and Instruction	New	Speeding Enforcement Concept Assessment Reasrch - Spanish Discussion Guide
252601	SPEED PREVENTION ENFORCEMENT CONCEPT ASSESSMENT RESEARCH ONLINE FOCUS GROUPS	Form	New	Speeding Enforcement Concept Assessment Research - Spanish Screener
252601	SPEED PREVENTION ENFORCEMENT CONCEPT ASSESSMENT RESEARCH ONLINE FOCUS GROUPS	Form and Instruction	New	Speeding Enforcement Concept Assessment Researcg - Discussion Guide
252601	SPEED PREVENTION ENFORCEMENT CONCEPT ASSESSMENT RESEARCH ONLINE FOCUS GROUPS	Form	New	Speed Enforcement Concept Assessment Research - English Screener
252462	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	Other-Web Survey	New
252343	SPEED PREVENTION SOCIAL NORMING CONCEPT ASSESSMENT RESEARCH ONLINE FOCUS GROUPS	Form	New	Speed Prevention Social Norming Concept Assessment Research Online Focus Group - Spanish Translation
252343	SPEED PREVENTION SOCIAL NORMING CONCEPT ASSESSMENT RESEARCH ONLINE FOCUS GROUPS	Form and Instruction	New	Speed Prevention Social Norming Concept Assessment Research Online Focus Groups - Discussion Guide Spanish
252343	SPEED PREVENTION SOCIAL NORMING CONCEPT ASSESSMENT RESEARCH ONLINE FOCUS GROUPS	Form	New	Speed Prevention Social Norming Concept Assessment Reseacrh Online Focus Group - Spanish Screener
252343	SPEED PREVENTION SOCIAL NORMING CONCEPT ASSESSMENT RESEARCH ONLINE FOCUS GROUPS	Form and Instruction	New	Speed Prevention Social Norming Concept Assessment Reseacrh Online Focus Groups - Discussion Guide
252343	SPEED PREVENTION SOCIAL NORMING CONCEPT ASSESSMENT RESEARCH ONLINE FOCUS GROUPS	Form	New	Speed Prevention Social Norming Concept Assessment Research Online Focus Groups - Recruitment Screener - English
251894	Rail Grade Crossing	Form	New	Rail Grade Crossing Creative Testing - Spanish Screeer Translation
251894	Rail Grade Crossing	Form	New	Rail Grade Crossing Creative Testing - Spanish Screener
251894	Rail Grade Crossing	Form and Instruction	New	Rail Grade Crossing Creative Testing - Discussion Guide Spanish
251894	Rail Grade Crossing	Form	New	Rail Grade Crossing Creative Testing - English Screener
251894	Rail Grade Crossing	Form and Instruction	New	Rail Grade Crossing Creative Testing - Discussion Guide English
251070	SPEED PREVENTION EXPLORATORY RESEARCH ONLINE FOCUS GROUPS	Form and Instruction	New	Speed Prevention - Spanish Discussion Guide
251070	SPEED PREVENTION EXPLORATORY RESEARCH ONLINE FOCUS GROUPS	Form and Instruction	New	Speed Prevention - English Discussion Guide
251070	SPEED PREVENTION EXPLORATORY RESEARCH ONLINE FOCUS GROUPS	Form	New	Speed Prevention - Spanish Screener
251070	SPEED PREVENTION EXPLORATORY RESEARCH ONLINE FOCUS GROUPS	Form	New	Speed Prevention - Spanish Screener - English Translation
251070	SPEED PREVENTION EXPLORATORY RESEARCH ONLINE FOCUS GROUPS	Form	New	Speed Prevention - English Screener
250547	2022 CLICK IT OR TICKET CREATIVE CONCEPT TESTING RESEARCH ONLINE FOCUS GROUPS	Form and Instruction	New	CIOT Discussion Guide - Spanish
250547	2022 CLICK IT OR TICKET CREATIVE CONCEPT TESTING RESEARCH ONLINE FOCUS GROUPS	Form and Instruction	New	CIOT Discussion Guide - English
250547	2022 CLICK IT OR TICKET CREATIVE CONCEPT TESTING RESEARCH ONLINE FOCUS GROUPS	Form	New	CIOT Screener - Spanish
250547	2022 CLICK IT OR TICKET CREATIVE CONCEPT TESTING RESEARCH ONLINE FOCUS GROUPS	Form	New	CIOT Screener - English
243280	SBIR Customer Satisfaction	Form and Instruction	New	SBIR Awardee Satisfaction
239420	Voluntary Web-Based Post-event Survey – DOT AAHM Small Business Day event	Form	New	AAHM Small Business Outreach Questions
237791	Voluntary Web-Based Post-event Survey – Veteran-Owned Small Business Day and Matchmaking event	Other-	New
237289	OSDBU IT Industry Day Post Event Survey	Instruction	New
233875	Voluntary Web-Based Post-event Survey – Small Business Matchmaking event	Other-List of questions	Unchanged
232503	Drug Impaired Research	Form	Unchanged	Screener Guide
232503	Drug Impaired Research	Instruction	Unchanged
232192	Small Business Program Updates WebPage Registration	Other-Survey Questions	Unchanged
232188	Survey for Seat Belt Safety Public Service Advertising Campaign	Instruction	Unchanged
231863	Distracted Driving Prevention Public Service Advertising Campaign	Instruction	Unchanged
231653	Small Business Opportunities Day Post-event Customer Satisfaction Survey	Instruction	Unchanged
231647	Focus Groups for Traffic and Motor Vehicle Safety Programs and Activities	Other-Questionare	Unchanged
231642	Non-Model Unmanned Aircraft Survey	Other-Questionare	Unchanged
231437	Focus Groups for Assessment of Creative Concepts Supporting a National Awareness Campaign to Reduce Drug-Impaired Driving	Other-Questionare	Unchanged
229375	Revisions to the Emergency Response Guidebook	Instruction	Unchanged
226302	Voluntary Web-Based Survey of Airport Concession Disadvantaged Business Enterprises and Disadvantaged Business Enterprise Firms	Form and Instruction	Unchanged	DBE Survey Questions
226302	Voluntary Web-Based Survey of Airport Concession Disadvantaged Business Enterprises and Disadvantaged Business Enterprise Firms	Form and Instruction	Unchanged	Voluntary Web-Based Inventory of Airport Concession Disadvantaged Business Enterprises and Disadvantaged Business Enterprise Firms

ICR Details

OMB Control No: 2105-0573	ICR Reference No: 201906-2105-001
Status: Historical Active	Previous ICR Reference No: 201811-2105-001
Agency/Subagency: DOT/OST	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/08/2019
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/21/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2022	36 Months From Approved	01/31/2020
Responses	80,000	0	6,000
Time Burden (Hours)	60,000	0	2,000
Cost Burden (Dollars)	3,000,000	0	300,000

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Abstract: The Department seeks an extension without change of a fast track generic clearance information collection request already approved by OMB. Existence of Fast Track option for conducting surveys has caused a sudden increase in number of surveys. OST has already used the 2000 burden hours previously approved. OST requests increasing the total burden hours to 60,000. This collection of information is necessary to enable OST program offices to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with those program office's programs.

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Authorizing Statute(s): EO: EO 13571 Name/Subject of EO: New Fast-Track for Collecting Service Delivery Feedback Under the Paperwork Reduction Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 11866	03/28/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 26177	06/05/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 25

table that charts list of burden

IC Title	Form No.	Form Name
2022 CLICK IT OR TICKET CREATIVE CONCEPT TESTING RESEARCH ONLINE FOCUS GROUPS	NHTSA Form 1631, NHTSA Form 1632, NHTSA Form 1634, NHTSA Form 1633	CIOT Screener - English ,   CIOT Screener - Spanish ,   CIOT Discussion Guide - English ,   CIOT Discussion Guide - Spanish
Awareness Campaign to Reduce Distracted Driving	NHTSA Form 1666, NHTSA Form 1336	Awareness Campaign to Reduce Distracted Driving - Screener ,   Awareness Campaign to Reduce Distracted Driving - Moderators Guide
Distracted Driving Prevention Public Service Advertising Campaign
Drug Impaired Research	1472	Screener Guide
Focus Groups for Assessment of Creative Concepts Supporting a National Awareness Campaign to Reduce Drug-Impaired Driving
Focus Groups for Traffic and Motor Vehicle Safety Programs and Activities
GENERIC CLEARANCE FOR THE COLLECTION OF QUALITATIVE FEEDBACK ON AD CONCEPTS FOR OFFICE OF DEFECTS INVESTIGATION VEHICLE RECALLS CAMPAIGN PROMOTION	NHTSA Form 1665, NHTSA Form 1664	2022 ODI Recall Creative Testing Research - Screener ,   2022 ODI Recall Creative Testing Research - Discussion Guide
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
MARIJUANA IMPAIRMENT EXPLORATORY RESEARCH ONLINE FOCUS GROUPS	NHTSA Form 1650, NHTSA Form 1652, NHTSA Form 1651, NHTSA Form 1653	Marijuana Impairment Exploratory Reseach - English Screener ,   Marijuana Impairment Exploratory Research - Discussion Guide ,   Marijuana Impairment Exploratory Research - Spanish Screener ,   Marijuana Impairment Exploratory Research - Spanish Discussion Guide
Non-Model Unmanned Aircraft Survey
OSDBU IT Industry Day Post Event Survey
REAR SEAT BELT CREATIVE TESTING RESEARCH ONLINE FOCUS GROUPS	NHTSA Form 1660, NHTSA Form 1661	Rear Seat Bealt Creative Testing Research - Screener ,   Rear Seat Belt Creative Testing Research - Discussion Guide
Rail Grade Crossing	NHTSA Form 1644, NHTSA Form 1642, NHTSA Form 1643, NHTSA Form 1645, NHTSA Form 1646	Rail Grade Crossing Creative Testing - Discussion Guide English ,   Rail Grade Crossing Creative Testing - English Screener ,   Rail Grade Crossing Creative Testing - Discussion Guide Spanish ,   Rail Grade Crossing Creative Testing - Spanish Screener ,   Rail Grade Crossing Creative Testing - Spanish Screeer Translation
Revisions to the Emergency Response Guidebook
SBIR Customer Satisfaction	SBIR - 001	SBIR Awardee Satisfaction
SPEED PREVENTION ENFORCEMENT CONCEPT ASSESSMENT RESEARCH ONLINE FOCUS GROUPS	NHTSA Form 1657, NHTSA Form 1655, NHTSA Form 1654, NHTSA Form 1656, NHTSA Form 1658	Speed Enforcement Concept Assessment Research - English Screener ,   Speeding Enforcement Concept Assessment Researcg - Discussion Guide ,   Speeding Enforcement Concept Assessment Research - Spanish Screener ,   Speeding Enforcement Concept Assessment Reasrch - Spanish Discussion Guide ,   Speeding Enforcement Concept Assessment Research - Spanish Translation
SPEED PREVENTION EXPLORATORY RESEARCH ONLINE FOCUS GROUPS	NHTSA Form 1637, NHTSA Form 1638, NHTSA Form 1639, NHTSA Form 1640, NHTSA Form 1641	Speed Prevention - English Screener ,   Speed Prevention - Spanish Screener - English Translation ,   Speed Prevention - Spanish Screener ,   Speed Prevention - English Discussion Guide ,   Speed Prevention - Spanish Discussion Guide
SPEED PREVENTION SOCIAL NORMING CONCEPT ASSESSMENT RESEARCH ONLINE FOCUS GROUPS	NHTSA Form 1657, NHTSA Form 1654, NHTSA Form 1655, NHTSA Form 1656, NHTSA Form 1658	Speed Prevention Social Norming Concept Assessment Research Online Focus Groups - Recruitment Screener - English ,   Speed Prevention Social Norming Concept Assessment Reseacrh Online Focus Groups - Discussion Guide ,   Speed Prevention Social Norming Concept Assessment Reseacrh Online Focus Group - Spanish Screener ,   Speed Prevention Social Norming Concept Assessment Research Online Focus Groups - Discussion Guide Spanish ,   Speed Prevention Social Norming Concept Assessment Research Online Focus Group - Spanish Translation
Small Business Opportunities Day Post-event Customer Satisfaction Survey
Small Business Program Updates WebPage Registration
Survey for Seat Belt Safety Public Service Advertising Campaign
Voluntary Web-Based Post-event Survey – DOT AAHM Small Business Day event	AAHM Small Business Outreach Questions	AAHM Small Business Outreach Questions
Voluntary Web-Based Post-event Survey – Small Business Matchmaking event
Voluntary Web-Based Post-event Survey – Veteran-Owned Small Business Day and Matchmaking event
Voluntary Web-Based Survey of Airport Concession Disadvantaged Business Enterprises and Disadvantaged Business Enterprise Firms	DBE Survey Questions, Voluntary Web-Based Inventory of Airport Concessio	Voluntary Web-Based Inventory of Airport Concession Disadvantaged Business Enterprises and Disadvantaged Business Enterprise Firms ,   DBE Survey Questions

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	80,000	6,000	0	74,000	0	0
Annual Time Burden (Hours)	60,000	2,000	0	58,000	0	0
Annual Cost Burden (Dollars)	3,000,000	300,000	0	2,700,000	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The Department seeks an extension without change of a fast track generic clearance information collection request already approved by OMB. Existence of Fast Track option for conducting surveys has caused a sudden increase in number of surveys. OST has already used the 2000 burden hours previously approved. OST requests increasing the total burden hours to 60,000.

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Annual Cost to Federal Government: $223,750

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/21/2019

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