[NCIPC] Formative Evaluation for Transportation Safety Resource for Action Tool

[OS] CDC/ATSDR Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Document Name Document Type
[NCIPC] Formative Evaluation for Transportation Safety Resource for Action Tool Form and Instruction
Email Invitation Att2_Email Invitations.docx Form and Instruction
First Follow-up Email Att3_Follow up email First.docx Form and Instruction
Second Follow-up Email Att4_Follow up email Second.docx Form and Instruction
Semi-Structured Interview Guide Att1_Semi-Structured Interview Guide.docx Form and Instruction
Att5_Research Determination.docx Research Determination IC Document
Att6_Privacy Act Determination.pdf Privacy Act Determination IC Document
Transportation Safey Resource for Action_SSA_GenIC_final.docx SSA IC Document
Transportation Safey Resource for Action_SSB_GenIC.docx SSB IC Document

Information Collection (IC) Details

IC Title:	[NCIPC] Formative Evaluation for Transportation Safety Resource for Action Tool	Agency IC Tracking Number:	0920-1154-25AV

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Email Invitation	Att2_Email Invitations.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	First Follow-up Email	Att3_Follow up email First.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Second Follow-up Email	Att4_Follow up email Second.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Semi-Structured Interview Guide	Att1_Semi-Structured Interview Guide.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 145	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	145	145
Annual IC Time Burden (Hours)	24	24
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Research Determination	Att5_Research Determination.docx	11/06/2024
Privacy Act Determination	Att6_Privacy Act Determination.pdf	11/06/2024
SSA	Transportation Safey Resource for Action_SSA_GenIC_final.docx	11/06/2024
SSB	Transportation Safey Resource for Action_SSB_GenIC.docx	11/06/2024

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