Information Collection

National Telephone Survey

IC 202111 under ICR 201302-2127-003 · OMB 2127-0669.

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 Attachment D DADSS Questionnaire Attachment D - DADSS Questionnaire 4_4_22_ 20 12_02_10_13 update.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_11_05.docx Attachment E Question-By-Question Justification	IC Document

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
Form	NHTSA Form 1157	Attachment D DADSS Questionnaire	Attachment D - DADSS Questionnaire 4_4_22_ 20 12_02_10_13 update.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	Change Due to Adjustment in Agency Estimate
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
Attachment E Question-By-Question Justification	Attachment E - Question_by_Question_Justification 4 2 12_11_05.docx	02/11/2013

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