Information Collection

Psychological Constructs Related to Seat Belt Use Survey Screener

IC 227882 under ICR 201708-2127-001 · OMB 2127-0729.

Documents and Forms

Document Name Document Type
Form 1365 Psychological Constructs Related to Seat Belt Use Survey Screener Form and Instruction
1365 Survey Screener PCRSBU Form 1365 Screener 021618.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Psychological Constructs Related to Seat Belt Use 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	1365	Survey Screener	PCRSBU Form 1365 Screener 021618.docx		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,197	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	10,197	10,197
Annual IC Time Burden (Hours)	170	170
Annual IC Cost Burden (Dollars)	4,385	4,385

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.