Information Collection

Evaluation Survey for Impaired Riding Interventions

IC 199532 under ICR 201109-2127-001 · OMB 2127-0685.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2127-0685 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment D - Question-By-Question Justification.docx	Instruction
NHTSA Form 1159 Evaluation Survey for Impaired Riding Interventions Attachment_C_-_Survey[1].docx	Form

IC Title:

Evaluation Survey for Impaired Riding Interventions

Agency IC Tracking Number:

Is this a Common Form? No

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment D - Question-By-Question Justification.docx		No		Paper Only
Form	NHTSA Form 1159	Evaluation Survey for Impaired Riding Interventions	Attachment_C_-_Survey[1].docx		No		Fillable Printable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 14,000

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
Annual Number of Responses for this IC	14,000	14,000
Annual IC Time Burden (Hours)	1,167	1,167
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.