NHTSA Form #1066 Supplemental Form--Mail-Back

United States Department of Transportation National Highway Traffic Safety Administration

SUPPLEMENTAL MAIL BACK FORM (04/14/10 Draft)

Form Approved O.M.B. No. 2127-0626 Expiration Date: XXXX National Automotive Sampling System Tire Pressure Monitoring System – Special Study

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. Public reporting for this collection of information is estimated to be approximately 10 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 1066

Official Use Only

1. Primary Sampling Unit Number ___ ___

2. Site Number ____________________

3. Observation Number ___ ___

4. Date of Observation ___ ___ / ___ ___ / 2010

5. SUP ID ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

6. Some TPMS have both a warning lamp to indicate low tire pressure and a malfunction lamp to indicate the TPMS is not working properly. Other TPMS have a combined warning and malfunction lamp. Does your TPMS have a:

   1. Warning Lamp No Yes Don’t Know

   2. Malfunction Lamp No Yes Don’t Know

   3. Combined Warning and Malfunction Lamp

No Yes Don’t Know

IF RESPONSE TO QUESTION #6.1 or 6.3 IS “YES”, CONTINUE; IF NOT, SKIP TO QUESTION #15

[Questions on TPMS Low Pressure Warning Lamp]

6. Do you know where your TPMS warning (combined) lamp is located? If yes, where? (Check one)

   1. No

   2. Yes, on instrument panel

   3. Yes, on rearview mirror

   4. Yes, roof console

   5. Yes, other (specify) ___________________

6. Has your TPMS warning (combined) lamp ever illuminated except during engine on/off cycles? If yes, how many times?

   1. No

   2. Yes, ___ ___ (Code approx. number of times)

   3. Yes, don’t know how many times.

   4. Don’t know if illuminated

IF RESPONSE TO QUESTION #8 IS “YES”, CONTINUE; IF NOT, SKIP TO QUESTION #15

6. When was the last time the warning (combined) lamp illuminated on this vehicle?

   1. Within the past month

   2. 1-3 months ago

   3. 4 or more months ago

   4. Continuously/repetitively

   5. Don’t know

6. What actions did you take the last time the TPMS warning (combined) lamp illuminated? (Check all that apply)

   1. Checked tire pressure

   2. Reset the TPMS

   3. Took vehicle to the dealer or a service facility

   4. Added air

   5. Did nothing (Skip to #14)

   6. Other (specify)_______________________

6. How long after you first noticed the lamp illuminated, did you take action?

   1. During the same trip (e.g., pulled over)

   2. Later the same day or within several days

   3. One or more weeks after

6. Did any of the tires need air? If yes, how many?

   1. No

   2. Yes, _________ (Code number of tires)

   3. Yes, don’t know how many tires.

   4. Don’t know if any of tires needed air.

IF RESPONSE TO QUESTION #12 IS “YES”, CONTINUE; IF NOT, SKIP TO QUESTION #14

6. Approximately how much air was needed in each tire? (Estimate on average if multiple tires needed air)

   1. Less than 5 PSI

   2. 5 to 10 PSI

   3. 10 to 15 PSI

   4. More than 15 PSI

   5. Don’t know

6. Have you or someone else checked the vehicle because the warning (combined) lamp was not working correctly? If yes, what was found to be the reason? (Check all that apply)

   1. No, did not check it

   2. Yes, needed re-set

   3. Yes, sensors or other part in the tire not working

   4. Yes, batteries needed to be changed

   5. Yes, light bulb needed to be replaced

   6. Yes, general problem with TPMS system

   7. Yes, don’t know

   8. Yes, other (specify) ______________________

-----------------------

6. Do you know how to reset (calibrate) your TPMS?

If yes, how do you do it? (Check one)

1. No

2. Yes, use button in vehicle

3. Yes, follow menu on display

4. Yes, only dealer/service station can do it

5. Yes, other (specify) ___________________

6. When should your TPMS be reset? (Check all that apply)

   1. Never

   2. When the tire pressure is checked

   3. When the tire pressure is changed

   4. When a tire is changed

   5. When the tires are rotated

   6. Don’t know

   7. Other (specify)_______________________

6. How easy or difficult is it to reset your TPMS?

   1. Very easy

   2. Somewhat easy

   3. Somewhat difficult

   4. Very difficult

   5. Don’t know

6. To what extent do you rely on your TPMS to tell you when your tires need air? (Check one)

   1. Rely fully on the TPMS

   2. Rely on TPMS, but also use other methods

   3. Don’t rely on TPMS, only use other methods

IF RESPONSE TO QUESTION #6.2 WAS “YES”, CONTINUE; IF NOT, END INTERVIEW

[Questions on TPMS Malfunction Warning Lamp]

6. Do you know where your TPMS malfunction lamp is located? If yes, where? (Check one)

   1. No

   2. Yes, on instrument panel

   3. Yes, on rearview mirror

   4. Yes, roof console

   5. Yes, other (specify) _______________

IF RESPONSE TO QUESTION #19 IS “YES”, CONTINUE; IF NOT, END INTERVIEW

6. Has your TPMS malfunction lamp ever illuminated, except during engine on/off cycles? If yes, how many times?

   1. No

   2. Yes, ___ ___ (Code approx. number of times)

   3. Yes, don’t know how many times.

   4. Don’t know if illuminated

IF RESPONSE TO QUESTION #20 IS “YES”, CONTINUE; IF NOT, END INTERVIEW

6. When was the last time the malfunction lamp illuminated on this vehicle?

   1. Within the past month

   2. 1-2 months ago

   3. 3-4 months ago

   4. More than 4 months ago

   5. Continuously/repetitively

   6. Don’t know

6. What actions did you take the last time the TPMS malfunction lamp illuminated? (Check all that apply)

   1. Did nothing-it often illuminates

   2. Did nothing-other reasons

   3. Reset the TPMS

   4. Took vehicle to the dealer or a service facility

   5. Self or others worked on vehicle

   6. Other (specify)_______________________

6. Have you or someone else checked the vehicle because the malfunction lamp was not working correctly? If yes, what was found to be the reason? (Check all that apply)

   1. No, did not check it

   2. Yes, needed re-set

   3. Yes, sensors or other part in the tire not working

   4. Yes, batteries needed to be changed

   5. Yes, light bulb needed to be replaced

   6. Yes, general problem with TPMS system

   7. Yes, don’t know

   8. Yes, other (specify) __________________

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-XXXX. Public reporting for this collection of information is estimated to be approximately XX 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