Information Collection

Older Driver Rearview Video Systems Informed Consent

IC 228912 under ICR 201711-2127-001 · OMB 2127-0731.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2127-0731 can be found here:

Documents and Forms

Document Name Document Type
Form 1399 Older Driver Rearview Video Systems Informed Consent Form and Instruction
1399 Informed Consent Older Driver Rearview Video Systems ICR Form 1399.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Older Driver Rearview Video Systems Informed Consent	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	1399	Informed Consent	Older Driver Rearview Video Systems ICR Form 1399.docx		Yes	No	Paper Only

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	335	335
Annual IC Cost Burden (Dollars)	8,322	8,322

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.