Information Collection

Evaluation Surveys for Impaired Driving and Safety Belt Interventions

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NHTSA Form 1010 Evaluation Surveys for Impaired Driving and Safety Belt Interventions	Form
NHTSA Form 1010 Click it or Ticket Mobilization Appendix D Click it or Ticket Mobilization Questionnaire.doc	Form
NHTSA Form 1010A Clickk it or Ticket Mobilization Screener Appendix E Click It or Ticket Mobilization Screener.docx	Form and Instruction
NHTSA Form 1011 Alcohol Crackdown Questionnaire Appendix F Alcohl Crackdown Questionnaire (2).doc	Form
NHTSA Form 1011A Alcohol Crackdown Screener Appendix G Alcohol Crackdown Screener.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

IC Status: New

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?	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

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 160,211

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
Annual Number of Responses for this IC	160,211	160,211
Annual IC Time Burden (Hours)	26,702	26,702
Annual IC Cost Burden (Dollars)	214,200	214,200

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.