Information Collection

Survey for Seat Belt Safety Public Service Advertising Campaign

IC 232188 under ICR 201608-2105-003 · OMB 2105-0573.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2105-0573 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Fast Track Clearance Request_Tween Seat Belt Safety_Online Survey_7.3.18.._.docx	Instruction
Tween Seat Belt Safety Survey_6.28.18.docx	Other-Survey Questions

IC Title:

Survey for Seat Belt Safety Public Service Advertising Campaign

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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
Instruction			Fast Track Clearance Request_Tween Seat Belt Safety_Online Survey_7.3.18.._.docx		Yes	Yes	Fillable Fileable
Other-Survey Questions			Tween Seat Belt Safety Survey_6.28.18.docx		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,900

Number of Respondents for Small Entity: 100

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,900	3,900
Annual IC Time Burden (Hours)	215	215
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.