National Automotive Sampling System (NASS), Crashworthiness Data System (CDS) Interview and Occupant Information

Forms and Documents

Document Name	Status
Form HS Form 433A National Automotive Sampling System (NASS), Crashworthiness Data System (CDS) Interview and Occupant Information Form	Modified
Attachment 5 - DOT HS 811 327.pdf Supplementary Document	2013-02-14
2127-0021 Part A_02142013.pdf Supporting Statement A	2013-02-14
Standard Medical Release Form.doc Supplementary Document	2009-11-23
NASSbrochure_Apr2008.pdf Supplementary Document	2009-11-23
2127-0021 Part B_02142013.pdf Supporting Statement B	2013-02-14

IC Document Collections

IC ID	Document Title	Status
44079	National Automotive Sampling System (NASS), Crashworthiness Data System (CDS) Interview and Occupant Information Form	Modified

ICR Details

OMB Control No: 2127-0021	ICR Reference No: 201209-2127-001
Status: Historical Active	Previous ICR Reference No: 200907-2127-005
Agency/Subagency: DOT/NHTSA	Agency Tracking No:
Title: National Automotive Sampling System (NASS), Crashworthiness Data System (CDS) Interview and Occupant Information
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/20/2013
	Date Received in OIRA: 12/01/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2014	36 Months From Approved	02/28/2013
Responses	9,971	0	13,500
Time Burden (Hours)	5,605	0	5,807
Cost Burden (Dollars)	0	0	0

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Abstract: NASS investigates high severity crashes, includes interviewing occupants and witnesses, inspecting crash scenes and vehicles, and obtaining medical records. Data used in programs to prevent crashes and reduce injuries when crashes occur.

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Authorizing Statute(s): PL: Pub.L. 89 - 563 106, 108, 112 Name of Law: National Traffic and Motor Vehicle Saftey Act of 1966
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 99	05/22/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 152	08/07/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
National Automotive Sampling System (NASS), Crashworthiness Data System (CDS) Interview and Occupant Information	HS Form 433A, HS Form 433B, HS Form 433D	Occupant Assessment Form ,   Occuoant Injury Form ,   Interview Form (A)

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	9,971	13,500	0	0	-3,529	0
Annual Time Burden (Hours)	5,605	5,807	0	0	-202	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The adjustment was a result of a reduction in the total number of respondents from 13500 to 9971, which slightly reduced the the burden hours by 202 hours (from 5,807 hours to 5,605 hours).

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Annual Cost to Federal Government: $12,530

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/01/2012

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