Information Collection

OBMS Study Intervention Questionnaire

IC 198645 under ICR 201107-2126-001 · OMB 2126-0050.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form MCSA-5853 OBMS Study Intervention Questionnaire	Form
MCSA-5853 OBMS Study Intervention Questionnaire MCSA-5853.OBMS.Intervention_questionnaire.051211.Use.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 49 CFR 1.73

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	MCSA-5853	OBMS Study Intervention Questionnaire	MCSA-5853.OBMS.Intervention_questionnaire.051211.Use.doc		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 7 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,250	1,250
Annual IC Time Burden (Hours)	313	313
Annual IC Cost Burden (Dollars)	0	0

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.