Transportation and Health Tool Website User Satisfaction Assessment

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⚠️ Notice: This information collection may be referencing outdated material.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 0923-0047 can be found here:

Documents and Forms

Document Name Document Type
Transportation and Health Tool Website User Satisfaction Assessment Form
A4_THT RcruitmntEmlTlphnIntrvwUsbltyTstrs.docx Instruction
A5_THT UsrStsfctnTlphneIntrvw.docx Other-Telephone Interview
A1_THTRcrtmntEmlOnlneUsrStsfcnSurvey.docx Instruction
User Satisfaction Survey A2_THT Online UsrStsfctnSrvy.docx Form
User Satisfaction Survey - screenshots A3_THT OnlneSrvyScrnshts.pdf Form
0923-0047 NCEH-ATSDR CustomerFeedback_THTUserSatisfactionAsses.pdf Request for Approval IC Document

Information Collection (IC) Details

IC Title:	Transportation and Health Tool Website User Satisfaction Assessment	Agency IC Tracking Number:	16AWD

IC Status: New

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	none	User Satisfaction Survey	A2_THT Online UsrStsfctnSrvy.docx	Yes	Yes	Fillable Fileable
Form	none	User Satisfaction Survey - screenshots	A3_THT OnlneSrvyScrnshts.pdf	Yes	Yes	Fillable Fileable
Instruction			A4_THT RcruitmntEmlTlphnIntrvwUsbltyTstrs.docx	Yes	Yes	Fillable Fileable
Other-Telephone Interview			A5_THT UsrStsfctnTlphneIntrvw.docx	Yes	No	Paper Only
Instruction			A1_THTRcrtmntEmlOnlneUsrStsfcnSurvey.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 450	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	450	450
Annual IC Time Burden (Hours)	78	78
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	0923-0047 NCEH-ATSDR CustomerFeedback_THTUserSatisfactionAsses.pdf	08/01/2016

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