Evaluation of New Child Pedestrian Curriculum

Evaluation of NHTSA'S Child Pedestrian Safety Curriculum

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Evaluation of New Child Pedestrian Curriculum	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	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 %

	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

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.