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Federal forms, ICRs, and supporting documents

Information Collection

Evaluation Surveys for Impaired Driving and Safety Belt Interventions

IC 197260 under ICR 201104-2127-003 · OMB 2127-0646.

Documents and Forms
Document Name
Document Type
Form
Form
Form and Instruction
Form
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Evaluation Surveys for Impaired Driving and Safety Belt Interventions
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form NHTSA Form 1010 Click it or Ticket Mobilization Appendix D Click it or Ticket Mobilization Questionnaire.doc No   Fillable Printable
Form and Instruction NHTSA Form 1010A Clickk it or Ticket Mobilization Screener Appendix E Click It or Ticket Mobilization Screener.docx No   Fillable Printable
Form NHTSA Form 1011 Alcohol Crackdown Questionnaire Appendix F Alcohl Crackdown Questionnaire (2).doc No   Fillable Printable
Form and Instruction NHTSA Form 1011A Alcohol Crackdown Screener Appendix G Alcohol Crackdown Screener.docx No   Fillable Printable

Transportation Ground Transportation

 

160,211 0
   
Individuals or Households
 
   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 160,211 0 160,211 0 0 0
Annual IC Time Burden (Hours) 26,702 0 26,702 0 0 0
Annual IC Cost Burden (Dollars) 214,200 0 214,200 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.