Information Collection

OBMS Study Intervention Questionnaire

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	OBMS Study Intervention Questionnaire	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:

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 %

	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

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.