Information Collection

Recruitment of Human Subjects for Driver Monitoring of Inattention and Impairment Using Vehicle Equipment (DrIIVE)

IC 208853 under ICR 201309-2127-003 · OMB 2127-0701.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NHTSA Form 1222 Recruitment of Human Subjects for Driver Monitoring of Inattention and Impairment Using Vehicle Equipment (DrIIVE)	Form
3- Pre-Visit Activity Log.doc	Other-Activity Log
5- Pre-Drive and Post-Drive Stanford Sleepiness Scale.doc	Other-Sleepiness Rating Scale
NHTSA Form 1222 Recruitment Questionnaire 1- Recrutiment Questionnaire.doc	Form
NHTSA Form 1223 Pre-Drive Sleep and Intake Questionnaire 2- Pre-Drive Sleep and Intake Questionnaire.doc	Form
NHTSA Form 1219 Morning Evening Questionnaire 4- Morning Evening Questionnaire.doc	Form
NHTSA Form 1221 Retrospective Sleepiness 6- RetrospectiveSleepiness_S1R.doc	Form

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	Available Electronically?	Electronic Capability
Form	NHTSA Form 1222	Recruitment Questionnaire	1- Recrutiment Questionnaire.doc	No	Fillable Printable
Form	NHTSA Form 1223	Pre-Drive Sleep and Intake Questionnaire	2- Pre-Drive Sleep and Intake Questionnaire.doc	No	Fillable Printable
Other-Activity Log			3- Pre-Visit Activity Log.doc	No	Fillable Printable
Form	NHTSA Form 1219	Morning Evening Questionnaire	4- Morning Evening Questionnaire.doc	No	Fillable Printable
Other-Sleepiness Rating Scale			5- Pre-Drive and Post-Drive Stanford Sleepiness Scale.doc	No	Fillable Printable
Form	NHTSA Form 1221	Retrospective Sleepiness	6- RetrospectiveSleepiness_S1R.doc	No	Fillable Printable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 168

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	168	168
Annual IC Time Burden (Hours)	247	247
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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