Study

Emergency Medical Services (EMS) Sleep Health and Fatigue Education

Documents and Forms

Document Name Document Type
Form 1463 Study Form and Instruction
1463 Baseline Survey Form1463-BaselineSurvey.pdf Form and Instruction
1465 Follow-up Survey Form1465-FollowUpSurvey.pdf Form and Instruction
1464 Text Message Queries Form1464-TextMessageQueriesScreenshots.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Study	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1463	Baseline Survey	Form1463-BaselineSurvey.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	1465	Follow-up Survey	Form1465-FollowUpSurvey.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	1464	Text Message Queries	Form1464-TextMessageQueriesScreenshots.pdf	Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,200	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	1,200	1,200
Annual IC Time Burden (Hours)	9,500	9,500
Annual IC Cost Burden (Dollars)	0	0

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.