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Survey of DWI Courts
Survey of DWI Courts
OMB: 2127-0694
IC ID: 206728
OMB.report
DOT/NHTSA
OMB 2127-0694
ICR 201304-2127-002
IC 206728
( )
Documents and Forms
Document Name
Document Type
Form NHTSA Form 1175
Survey of DWI Courts
Form
NHTSA Form 1175 Welcome Screen For Entry To Questionnaire
Welcome Screen For Entry To Questionnaire.docx
Form
NHTSA Form 1175 DWI Court Survey Questionnaire
Attachment 4 - Questionnaire.docx
Form
Attachment 1 - Statutory Authority.pdf
Attachment 1 - Statutory Authority
IC Document
Attachment 2 - 60 Day Federal Register Notice.pdf
Attachment 2 - 60 Day Federal Register Notice
IC Document
Attachment 3 - 30 Day Federal Register Notice.pdf
Attachment 3 - 30 Day Federal Register Notice
IC Document
Attachment 5 - Question By Question Justification.docx
Attachment 5 - Question-By-Question Justification
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Survey of DWI Courts
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 1175
Welcome Screen For Entry To Questionnaire
Welcome Screen For Entry To Questionnaire.docx
Yes
Yes
Fillable Fileable
Form
NHTSA Form 1175
DWI Court Survey Questionnaire
Attachment 4 - Questionnaire.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Transportation
Subfunction:
Ground Transportation
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
650
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
650
0
650
0
0
0
Annual IC Time Burden (Hours)
433
0
433
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attachment 1 - Statutory Authority
Attachment 1 - Statutory Authority.pdf
04/30/2013
Attachment 2 - 60 Day Federal Register Notice
Attachment 2 - 60 Day Federal Register Notice.pdf
04/30/2013
Attachment 3 - 30 Day Federal Register Notice
Attachment 3 - 30 Day Federal Register Notice.pdf
04/30/2013
Attachment 5 - Question-By-Question Justification
Attachment 5 - Question By Question Justification.docx
04/30/2013
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.