Information Collection

Survey of DWI Courts

IC 206728 under ICR 201304-2127-002 · OMB 2127-0694.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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 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

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	650	650
Annual IC Time Burden (Hours)	433	433
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.