Eligibility Determination

Recruitment and Debriefing of Human Subjects for Field Test of Vehicle Occupant Protection Technologies

Documents and Forms

Document Name Document Type
Form NHTSA Form 1282 Eligibility Determination Form
NHTSA Form 1282 Eligibility Questionnaire Eligibility Questionnaire NHTSA Form 1282_JK_10262015docx.docx Form

Information Collection (IC) Details

IC Title:	Eligibility Determination	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	NHTSA Form 1282	Eligibility Questionnaire	Eligibility Questionnaire NHTSA Form 1282_JK_10262015docx.docx		No		Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 391	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	391	391
Annual IC Time Burden (Hours)	65	65
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.