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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.