Information Collection

Evaluation Surveys for Impaired Driving and Safety Belt Interventions

IC 184552 under ICR 201005-2127-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form NHTSA 1010 Evaluation Surveys for Impaired Driving and Safety Belt Interventions	Form and Instruction
NHTSA 1010 Click It or Ticket It Surveys NHTSA 1010.DOC	Form and Instruction
NHTSA 1011 You Drink and Drive You Loose Telephone Surveys NHTSA 1011.DOC	Form and Instruction
NHTSA 1103 Demonstration Surveys OMB-Request for Survey Approval 2 (2)-May 26 2010 (2).docx	Form

IC Title:

Evaluation Surveys for Impaired Driving and Safety Belt Interventions

Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NHTSA 1010	Click It or Ticket It Surveys	NHTSA 1010.DOC	Yes	No	Fillable Fileable
Form and Instruction	NHTSA 1011	You Drink and Drive You Loose Telephone Surveys	NHTSA 1011.DOC	Yes	No	Fillable Fileable
Form	NHTSA 1103	Demonstration Surveys	OMB-Request for Survey Approval 2 (2)-May 26 2010 (2).docx	Yes	No	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 8,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	8,000	-156,800	164,800
Annual IC Time Burden (Hours)	1,333	-26,135	27,468
Annual IC Cost Burden (Dollars)	15,896	-311,562	327,458

Documents for IC

table that charts IC Documents
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.