Survey
Research Laboratory (MC 336) 600
College of Urban Planning and Public Affairs Hall 412
South Peoria Street Chicago,
Illinois 60607
CSID
Dear Anne,
I am interested in participating in the transit behavior study (SRL#1107) and have completed the form below.
Name
Is the address below your current address? Yes No
ADDR
CITY,STATE, ZIP
Telephone Number Alternate Phone Number
This is my:
Home phone
Cell phone
Work phone
This is my:
Home phone
Cell phone
Work phone
E-mail address
Do you work or go to school outside the home?
Yes
No →SKIP TO Q.3
Please give the location (either the street address or cross-streets) of your work or school:
Street
City, State, ZIP
In a typical week, how many times do you go to your nearest Chicago Transit Authority (CTA) rail station, or within half a mile of that station?
0 times
Less than 1 time
Between 1 and 2 times
3 or more times
This collection of information is voluntary and will be used to gauge potential travel-behavior response to far-reaching improvements in the pedestrian, cycling, and transit environments of neighborhoods. Public reporting burden is estimated to average 1 hour and 45 minutes per response, including the time for reviewing instructions searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is 2125-XXXX (state OMB #). Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Highway Administration, 1200 New Jersey Avenue, SE, Washington, DC 20590.
Phone
(312) 996-5300 • Fax (312) 413-3358 • www.srl.uic.edu
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Patrick J. Falso |
File Modified | 0000-00-00 |
File Created | 2021-01-31 |