Form NHTSA Form 1417 NHTSA Form 1417 District Screening Dialogue to Gather Interest

OMB Control Number: XXXX-XXX

Expiration Date: XX/XX/XXXX

Under the Paperwork Reduction Act, a federal agency may not conduct or sponsor, and a person is not required to respond to collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control number. The OMB Control Number for this information collection is XXXX-XXXX (expiration date: MM/DD/YYYY). The average amount of time to complete the screening is 5 minutes. All responses to this collection of information are voluntary. If you have comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden send them to Information Collection Clearance Officer, National Highway Traffic Safety Administration, W51-312, 1200 New Jersey Ave, S.E., Washington, DC, 20590.

School District Screening Dialogue to Gather Interest

Example Dialogue:

NHTSA seeks to understand the school district decision-making process when considering whether – and how – to implement 2-point lap belts and 3-point lap-shoulder belts on school buses in the United States. NHTSA’s contractors, ToXcel and North Carolina State University are partnering to support this evaluation.

This study seeks to interview a representative selection of school districts related to seat belts on school buses – including those that have and have not implemented and/or required seat belt use. Public comments provided to NHTSA noted that it will be helpful to get input from school districts with a wide variety of perspectives regarding the acquisition and use of seat belts – and we agree.

To that end, we are identifying school districts that fall into one of several categories. To gather this information, we have designed a few questions that will help us to learn more about implementation experience and identify school districts who are interested in providing more information for this project. We plan to follow up with some of the school districts that we identify to gain further information. The number of districts interviewed will depend on the responses.

The member of the research team will provide the following statement to the volunteer before asking the screening questions:

Screening Questions:

1. District/Organization Name:

2. Contractor Name (if applicable):

3. Contact Name:

   1. (name of the best person to contact for this district/organization about school bus seat belt implementation)

4. Contact Title:

5. Contact Email Address and/or Phone Number:

6. Can we contact you to gain additional information about your district?

7. Which describes the status of school bus seat belt implementation for your district/organization?

   1. Have not considered implementing 2-point or 3-point belts

      1. (go to question 10)

   2. Have considered implementing 2-point or 3-oint belts but decided not to do so

      1. (go to question 8, then 10)

   3. Have implemented/are implementing 2-point or 3-point belts

      1. (go to question 9, then 10)

   4. Other:

      1. (go to question 10)

8. Please provide details about why your district/organization decided not to implement belts. Select ONE option for each line.

	Primarily Funding	Primarily Other Reasons	Equal Mix of Funding & other reasons	N/A
Lap Belts
Lap Shoulder Belts
Combination of Lap Belts and Lap Shoulder Belts

9. Please provide belt usage details for your district/organization. Select ONE option for each line.

	Adopted a policy that requires students to use the belts	Did NOT adopt a required use policy. Usage is left up to the individual drive and/or students	N/A
Lap Belts
Lap Shoulder Belts
Combination of Lap Belts and Lap Shoulder Belts

10. Please provide any additional comments related to school seat belts for your district/organization.

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NHTSA Form 1417