Information Collection

Evaluation Survey for Impaired Riding Interventions

IC 199532 under ICR 201203-2127-004 · OMB 2127-0685.

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 Survey for Evaluation of Impaired Riding Interventions Attachment C - Survey 6-10-12.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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		Printable Only
Form and Instruction	NHTSA Form 1159	Survey for Evaluation of Impaired Riding Interventions	Attachment C - Survey 6-10-12.docx		No		Fillable Printable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,040

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,040	5,040
Annual IC Time Burden (Hours)	672	672
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.