NHTSA Form 1060 Daily Site Form Tallies & Inspection

ATTACHMENT D1

Paperwork Reduction Act Burden Statement

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-0626. Since data will be collected on this form via observation, public reporting for this collection of information is estimated to be approximately 0 minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590. NHTSA Form 1060

U.S. Department of Transportation National Highway Traffic Safety Administration		DAILY SITE FORM TALLIES & INSPECTIONS (5/18/10 Draft)		Form Approved O.M.B. No. 2127-0626 Expiration Date: XXXX National Automotive Sampling System Tire Pressure Monitoring System-Special Study
	Primary Sampling Unit Number:		Site Number:
	Researcher 1		Researcher 2:
	Date of Observation: _______/_______/2010		Area : Urban, Suburban, : Rural Zip Code ___ ___ ___ ___ ___
	Spanish Speaker Available: No Yes, all day Yes, partial day		Time Period: From To

VEHICLE

VEHICLE BODY TYPE COUNT TALLIES

TALLY

INSP.

REFUSAL

BODY TYPES

08:00 - 08:15

10:00 - 10:15

12:00 - 12:15

02:00 - 02:15

04:00 - 04:15

TOTAL

TOTAL

TOTAL

SMALL AUTOS

LARGE AUTOS

UTILITY VEHICLES

VAN BASED LIGHT TRUCKS

LIGHT CONV. TRUCKS

TOTALS FOR THE DAY

15. NOTES