MVOSS Pilot Test

Motor Vehicle Occupant Safety Survey

Documents and Forms

Document Name Document Type
Form NHTSA FORM 1020 MVOSS Pilot Test Form and Instruction
NHTSA FORM 1020 Welcome Screen Welcome Screen For Entry To Questionnaire.docx Form and Instruction
NHTSA Form 1020A Version A Questionnaire Version A MVOSS (1) Questionnaire.doc Form
NHTSA Form 1020B Version B Questionnaire Version B MVOSS (1) Questionnaire.doc Form

Information Collection (IC) Details

IC Title:	MVOSS Pilot Test	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NHTSA FORM 1020	Welcome Screen	Welcome Screen For Entry To Questionnaire.docx	TBD	Yes	Yes	Fillable Fileable
Form	NHTSA Form 1020A	Version A Questionnaire	Version A MVOSS (1) Questionnaire.doc	TBD	Yes	Yes	Fillable Fileable
Form	NHTSA Form 1020B	Version B Questionnaire	Version B MVOSS (1) 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: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	375	375
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.