Information Collection

Evaluation Surveys for Impaired Driving and Seat Belt Interventions

IC 178882 under ICR 200702-2127-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 NHTSA 1010 Evaluation Surveys for Impaired Driving and Seat Belt Interventions	Form and Instruction
NHTSA 1010 Demo Project: Night Belt Enforcement, Ashville, NC 2127-0646 Demo Project Survey Ashville NC.doc	Form and Instruction
NHTSA 1010 Demo Project: Night Belt Enforcement, Greenville, NC 2127-0646 Demo Project Survey Greenville NC.doc	Form and Instruction
NHTSA 1010 Demo Project: Night Belt Enforcement, Charleston, WV 2127-0646 Demo Project Surey Charleston WV.doc	Form and Instruction

IC Title:

Evaluation Surveys for Impaired Driving and Seat Belt Interventions

Agency IC Tracking Number:

IC Status: New

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 and Instruction	NHTSA 1010	Demo Project: Night Belt Enforcement, Ashville, NC	2127-0646 Demo Project Survey Ashville NC.doc	No	Fillable Fileable
Form and Instruction	NHTSA 1010	Demo Project: Night Belt Enforcement, Greenville, NC	2127-0646 Demo Project Survey Greenville NC.doc	No	Fillable Fileable
Form and Instruction	NHTSA 1010	Demo Project: Night Belt Enforcement, Charleston, WV	2127-0646 Demo Project Surey Charleston WV.doc	No	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16,000

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	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	128,000	0	0	0	0	0
Annual IC Time Burden (Hours)	21,333	0	0	0	0	0
Annual IC Cost Burden (Dollars)	25,600	0	0	0	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.