Information Collection

Telephone Surveys

IC 200677 under ICR 201201-2127-001 · OMB 2127-0709.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2127-0709 can be found here:

Documents and Forms

Document Name Document Type
Form NHTSA Form 1121 Telephone Surveys Form
NHTSA Form 1121 Telephone Survey Questionnaire Appendix_D_Telephone_Survey_Questionnaire_and_Screener_12-14-111.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Telephone Surveys	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
Form	NHTSA Form 1121	Telephone Survey Questionnaire	Appendix_D_Telephone_Survey_Questionnaire_and_Screener_12-14-111.docx		No		Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	18,000	18,000
Annual IC Time Burden (Hours)	3,000	3,000
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.