Form NHTSA FORM 1020 NHTSA FORM 1020 Welcome Page

OMB No. 2127-0645

Expiration Date: XX/XX/201X

National Highway Traffic Safety Administration (NHTSA)

U.S. Department of Transportation

Motor Vehicle Occupant Safety Survey (MVOSS)

Thank you for taking a few minutes to complete this survey. The information you provide will contribute to what has been one of the most successful programs in improving the public welfare in the United States. Traffic safety programs have saved thousands of lives and prevented countless injuries. Their success has been dependent on the quality of information used to design the programs. NHTSA is conducting this survey to get current information on what people think and do when driving and riding in motor vehicles. Results will be used to improve safety among people of all ages.

The survey is voluntary and will take 15 minutes to complete. The information you provide will be kept separate from the information used to contact you so that your survey responses are anonymous. Survey results will be distributed only as summary statistics that cannot be used to identify anyone.

Only people 16 and older are eligible to participate in the survey. If you are age 16 or 17, one of your parents, or a guardian if no parent is present, must give written consent for you to participate in the survey. Click Parent/Guardian for further instructions. Parent/Guardian

Please answer the questions as accurately as you can. You don’t have to answer a question if it makes you uncomfortable. But remember that your answers will always be kept strictly private, and it’s important for the survey to obtain a full picture in order to develop effective ways of improving safety.

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Paperwork Reduction Act Burden Statement: Under the Paperwork Reduction Act, a federal agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-0645. The average amount of time to complete this survey is 15 minutes. All responses to this collection of information are voluntary. If you have comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, send them to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590

NHTSA Form 1020