Information Collection

Testing

IC 233911 under ICR 201811-2127-002 · OMB 2127-0736.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1445 Testing	Form and Instruction
1445 Activity Log Form1445_ActivityLog_v9_7_18_18.docx	Form and Instruction
1446 Sleep Questionnaire Form1446_SleepQuestionnaire_v10_7_18_18.doc	Form and Instruction
1447 Stanford Sleepiness Scale Form1447_StanfordSleepinessScale_v10_7_18_18.doc	Form and Instruction
1448 Drive Break Survey Form1448_DriveBreakSurvey_v10_7_18_18.docx	Form and Instruction
1449A Post Drive Survey (Baseline) Form1449A_PostDriveSurvey_Baseline_v10_7_18_18.docx	Form and Instruction
1449B Post Drive Survey (Lane Departure Warning) Form1449B_PostDriveSurvey_LDW_v10_7_18_18.docx	Form and Instruction
1449C Post Drive Survey (Drowsiness Mitigation and Lane Depart Form1449C_PostDriveSurvey_DM+LDW_v10_7_18_18.docx	Form and Instruction

IC Title:

Testing

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1445	Activity Log	Form1445_ActivityLog_v9_7_18_18.docx	Yes	Yes	Fillable Printable
Form and Instruction	1446	Sleep Questionnaire	Form1446_SleepQuestionnaire_v10_7_18_18.doc	Yes	Yes	Fillable Printable
Form and Instruction	1447	Stanford Sleepiness Scale	Form1447_StanfordSleepinessScale_v10_7_18_18.doc	Yes	Yes	Fillable Printable
Form and Instruction	1448	Drive Break Survey	Form1448_DriveBreakSurvey_v10_7_18_18.docx	Yes	Yes	Fillable Printable
Form and Instruction	1449A	Post Drive Survey (Baseline)	Form1449A_PostDriveSurvey_Baseline_v10_7_18_18.docx	Yes	Yes	Fillable Printable
Form and Instruction	1449B	Post Drive Survey (Lane Departure Warning)	Form1449B_PostDriveSurvey_LDW_v10_7_18_18.docx	Yes	Yes	Fillable Printable
Form and Instruction	1449C	Post Drive Survey (Drowsiness Mitigation and Lane Departure Warning)	Form1449C_PostDriveSurvey_DM+LDW_v10_7_18_18.docx	Yes	Yes	Fillable Printable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 75

Number of Respondents for Small Entity: 0

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	75	75
Annual IC Time Burden (Hours)	713	713
Annual IC Cost Burden (Dollars)	19,181	19,181

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.