Information Collection

Evaluation of New Child Pedestrian Curriculum

IC 210212 under ICR 201401-2127-002 · OMB 2127-0700.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NHTSA Form 1217 Evaluation of New Child Pedestrian Curriculum	Form
NHTSA Form 1217 Student Survey Johnson - Appendix C-1 Student Survey[1].docx	Form
NHTSA Form 1216 Caregiver Survey - English Johnson - Appendix C-2 Caregiver Survey English[1].docx	Form
NHTSA Form 1215 Instructional Staff Survey Johnson - Appendix C-4 Instructional Staff Survey[1].docx	Form and Instruction
NHTSA Form 1216A Caregiver Survey - Spanish Johnson - Appendix C-3 Caregiver Survey Spanish[1].docx	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?	Can Be Submitted Electronically?	Electronic Capability
Form	NHTSA Form 1217	Student Survey	Johnson - Appendix C-1 Student Survey[1].docx	No		Paper Only
Form	NHTSA Form 1216	Caregiver Survey - English	Johnson - Appendix C-2 Caregiver Survey English[1].docx	No		Paper Only
Form and Instruction	NHTSA Form 1215	Instructional Staff Survey	Johnson - Appendix C-4 Instructional Staff Survey[1].docx	Yes	Yes	Fillable Printable
Form	NHTSA Form 1216A	Caregiver Survey - Spanish	Johnson - Appendix C-3 Caregiver Survey Spanish[1].docx	No		Paper Only

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 3 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,200	6,200
Annual IC Time Burden (Hours)	517	517
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.