Information Collection

Young Driver Survey

IC 211033 under ICR 201403-2127-005 · OMB 2127-0704.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NHTSA Form 1199 Young Driver Survey	Form and Instruction
NHTSA Form 1199 Welcome Screen Welcome Screen For Entry To Questionnaire.docx	Form and Instruction
NHTSA Form 1199(a) Questionnaire Version A March 2014 Web Version A Questionnaire.doc	Form
NHTSA Form 1199(b) Questionnaire Version B March 2014 Web Version B Questionnaire.doc	Form

IC Title:

Young Driver Survey

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 and Instruction	NHTSA Form 1199	Welcome Screen	Welcome Screen For Entry To Questionnaire.docx	TBD	Yes	Yes	Fillable Fileable
Form	NHTSA Form 1199(a)	Questionnaire Version A	March 2014 Web Version A Questionnaire.doc	TBD	Yes	Yes	Fillable Fileable
Form	NHTSA Form 1199(b)	Questionnaire Version B	March 2014 Web Version B Questionnaire.doc	TBD	Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 64,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	64,000	64,000
Annual IC Time Burden (Hours)	16,000	16,000
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.