Information Collection

Motor Vehicle Occupant Safety Survey

IC 26354 under ICR 201406-2127-006 · OMB 2127-0645.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NHTSA FORM 1020 Motor Vehicle Occupant Safety Survey	Form and Instruction
NHTSA FORM 1020 Welcome Page 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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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 1020	Welcome Page	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: 12,000

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	12,000	12,000
Annual IC Time Burden (Hours)	3,000	3,000
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.