Information Collection

Impaired Driving Survey

IC 222278 under ICR 201704-2127-002 · OMB 2127-0725.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1322 Impaired Driving Survey	Form and Instruction
1322 Impaired Driving Survey Appendix B Impaired Driving Survey Form 1322 04052017.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

1322

Is this a Common Form? No

IC Status: Modified

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	1322	Impaired Driving Survey	Appendix B Impaired Driving Survey Form 1322 04052017.docx		No		Paper Only

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,400

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	2,400	2,400
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	9,288	9,288

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.