Click It or Ticket Next Generation Surveys

Evaluation Surveys for Impaired Driving and Safety Belt Interventions

⚠️ Notice: This information collection may be referencing outdated material.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 1012 Click It or Ticket Next Generation Surveys Form
NHTSA 1012 Virginia Seat Belt Survey VA Survey.doc Form
NHTSA 1012 Iowa Seat Belt Survey IA Survey.doc Form
NHTSA 1012 Pennsylvania Seat Belt Survey PA Survey.doc Form

Information Collection (IC) Details

IC Title:	Click It or Ticket Next Generation Surveys	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?	Can Be Submitted Electronically?	Electronic Capability
Form	NHTSA 1012	Iowa Seat Belt Survey	IA Survey.doc	Yes	Yes	Fillable Fileable
Form	NHTSA 1012	Pennsylvania Seat Belt Survey	PA Survey.doc	Yes	Yes	Fillable Fileable
Form	NHTSA 1012	Virginia Seat Belt Survey	VA Survey.doc	Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,000	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	10,000	0	0	0	0	0
Annual IC Time Burden (Hours)	1,667	0	0	0	0	0
Annual IC Cost Burden (Dollars)	6,250	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.