Information Collection

Older Drivers' Self-Regulation and Exposure Consent Form

IC 220193 under ICR 201602-2127-004 · OMB 2127-0722.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1332 Older Drivers' Self-Regulation and Exposure Consent Form	Form and Instruction
1332 Older Drivers’ Self-Regulation and Exposure Consent Form Appendix F Form1332 Informed Consent.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	1332	Older Driversâ Self-Regulation and Exposure Consent Form	Appendix F Form1332 Informed Consent.doc		Yes	No	Printable Only

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	2,928	2,928

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.