Information Collection

Eligibility Determination

IC 218413 under ICR 201509-2127-003 · OMB 2127-0716.

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

View Information Collection (IC)

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.