Form NHTSA Form 1060 NHTSA Form 1060 Daily Site Form Tallies & Inspection

National Automotive Sampling System Tire Pressure Monitoring System Study (TPMSS)

01-ATT D1--Daily Site--Body Types

National Automotive Sampling System Tire Pressure Monitoring System Study (TPMSS)

OMB: 2127-0626

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A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-0626. Since data will be collected on this form via observation, public reporting for this collection of information is estimated to be approximately 0 minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590. NHTSA Form 1060

U.S. Department of Transportation

National Highway Traffic Safety

Administration


DAILY SITE FORM

TALLIES & INSPECTIONS

(5/18/10 Draft)

Form Approved O.M.B. No. 2127-0626

Expiration Date: XXXX


National Automotive Sampling System

Tire Pressure Monitoring System-Special Study



  1. Primary Sampling Unit Number:

  1. Site Number:


  1. Researcher 1

  1. Researcher 2:


  1. Date of Observation: _______/_______/2010

  1. Area : Urban, Suburban, : Rural Zip Code ___ ___ ___ ___ ___


  1. Spanish Speaker Available: No Yes, all day Yes, partial day

  1. Time Period: From To


  1. VEHICLE

  1. VEHICLE BODY TYPE COUNT TALLIES

  1. TALLY

  1. INSP.

  1. REFUSAL

BODY TYPES

08:00 - 08:15

10:00 - 10:15

12:00 - 12:15

02:00 - 02:15

04:00 - 04:15

TOTAL

TOTAL

TOTAL

SMALL AUTOS









LARGE AUTOS









UTILITY VEHICLES









VAN BASED LIGHT TRUCKS









LIGHT CONV. TRUCKS









  1. TOTALS FOR THE DAY





  1. NOTES





File Typeapplication/msword
AuthorCharlene.Doyle
Last Modified Bycharlene.doyle
File Modified2010-05-18
File Created2010-05-18

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