Information Collection

National Telephone Survey

IC 202111 under ICR 201204-2127-005 · OMB 2127-0669.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2127-0669 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NHTSA Form 1157 National Telephone Survey	Form
NHTSA Form 1157 DADSS National Telephone Survey Questionnaire Attachment D - DADSS Questionnaire 4_4_22_ 20 12.docx	Form
Attachment A Statutory Authority.pdf Statutory Authority	IC Document
Attachment B - 60 Day Federal Register Notice.pdf 60-Day Federal Register Notice	IC Document
Attachment C - 30 Day Federal Register Notice.pdf 30-Day Federal Register Notice	IC Document
Attachment E - Question_by_Question_Justification 4 2 12.docx Question-By-Question Justification	IC Document

IC Title:

National Telephone Survey

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
Form	NHTSA Form 1157	DADSS National Telephone Survey Questionnaire	Attachment D - DADSS Questionnaire 4_4_22_ 20 12.docx		No		Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,025

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,025	1,025
Annual IC Time Burden (Hours)	256	256
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Statutory Authority	Attachment A Statutory Authority.pdf	05/01/2012
60-Day Federal Register Notice	Attachment B - 60 Day Federal Register Notice.pdf	05/01/2012
30-Day Federal Register Notice	Attachment C - 30 Day Federal Register Notice.pdf	05/01/2012
Question-By-Question Justification	Attachment E - Question_by_Question_Justification 4 2 12.docx	05/01/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.