Information Collection

Survey Screener

IC 222277 under ICR 201606-2127-001 · OMB 2127-0725.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2127-0725 can be found here:

Documents and Forms

Document Name Document Type
Form 1321 Survey Screener Form and Instruction
1321 Survey Screener Appendix A Survey Screener Form 1321 07012016.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Survey Screener	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	1321	Survey Screener	Appendix A Survey Screener Form 1321 07012016.docx		No		Paper Only

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16,416	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	16,416	16,416
Annual IC Time Burden (Hours)	1,368	1,368
Annual IC Cost Burden (Dollars)	31,847	31,847

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.