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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.