NIOSH Center for Motor Vehicle Safety Needs Assessment and Audience Analysis

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIOSH 2)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:

Documents and Forms

Document Name Document Type
Screener.docx Other-WORD
DemogSurvey.docx Other-WORD
ModeratorGuide.docx Other-WORD
Consent Form.docx Consent Form IC Document
Motor Vehicle Safety Needs Assessment.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	NIOSH Center for Motor Vehicle Safety Needs Assessment and Audience Analysis	Agency IC Tracking Number:	17JI

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-WORD	Screener.docx	No	Paper Only
Other-WORD	DemogSurvey.docx	No	Fillable Fileable
Other-WORD	ModeratorGuide.docx	No	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 36	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	72	72
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Consent Form	Consent Form.docx	01/03/2017
Request for Approval	Motor Vehicle Safety Needs Assessment.docx	01/11/2017

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