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Evaluation Surveys for Impaired Driving and Safety Belt Interventions
Evaluation Surveys for Impaired Driving and Safety Belt Interventions
OMB: 2127-0646
IC ID: 179366
OMB.report
DOT/NHTSA
OMB 2127-0646
ICR 200703-2127-004
IC 179366
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2127-0646 can be found here:
2011-05-02 - Revision of a currently approved collection
2010-06-21 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form NHTSA 1012
Evaluation Surveys for Impaired Driving and Safety Belt Interventions
Form and Instruction
NHTSA 1012 Iowa Seat Belt Survey
2127-0646 IA Survey.doc
Form and Instruction
NHTSA 1012 Pennsylvania Seat Belt Survey
2127-0646 PA Survey.doc
Form and Instruction
NHTSA 1012 Virginia Seat Belt Survey
2127-0646 VA Survey.doc
Form and Instruction
OMB 2127-0646 Modification for State Surveys (CIOT NEXT GENERATION).doc
Additonal Information on State Surveys
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Evaluation Surveys for Impaired Driving and Safety 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
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
NHTSA 1012
Iowa Seat Belt Survey
2127-0646 IA Survey.doc
No
Fillable Fileable
Form and Instruction
NHTSA 1012
Pennsylvania Seat Belt Survey
2127-0646 PA Survey.doc
No
Fillable Fileable
Form and Instruction
NHTSA 1012
Virginia Seat Belt Survey
2127-0646 VA Survey.doc
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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
16,000
0
0
0
0
0
Annual IC Time Burden (Hours)
2,667
0
0
0
0
0
Annual IC Cost Burden (Dollars)
32,000
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Additonal Information on State Surveys
OMB 2127-0646 Modification for State Surveys (CIOT NEXT GENERATION).doc
03/28/2007
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.