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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.