Information Collection

Evaluation Surveys for Impaired Driving and Safety Belt Interventions

IC 26355 under ICR 200701-2127-005 · OMB 2127-0646.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2127-0646 can be found here:

Documents and Forms

Document Name Document Type
Form NHTSA1010 Evaluation Surveys for Impaired Driving and Safety Belt Interventions Form
NHTSA1010 Demonstration Project Night Belt Enforcement 2127-0646 Demo NHSTA 1010.DOC Form
NHTSA1011 Alcohol Mobilization 2127-0646 Alcohol NHTSA 1011.DOC Form
NHTSA1012 Saet Belt Mobilization 2127-0646 Safety Belt NHTSA 1012.DOC Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Evaluation Surveys for Impaired Driving and Safety Belt Interventions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	NHTSA1010	Demonstration Project Night Belt Enforcement	2127-0646 Demo NHSTA 1010.DOC	No	Fillable Fileable
Form	NHTSA1011	Alcohol Mobilization	2127-0646 Alcohol NHTSA 1011.DOC	No	Fillable Fileable
Form	NHTSA1012	Saet Belt Mobilization	2127-0646 Safety Belt NHTSA 1012.DOC	No	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	24,000	24,000
Annual IC Time Burden (Hours)	4,000	4,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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