Evaluation Survey for Impaired Riding Interventions

Evaluation of Impaired Riding Interventions

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.