Study Subset for Additional Collection

Emergency Medical Services (EMS) Sleep Health and Fatigue Education

Documents and Forms

Document Name Document Type
Form 1466 Study Subset for Additional Collection Form and Instruction
1466 Sleep diary Form1466-PaperSleepDiary.docx Form and Instruction
1467 Psychomotor Vigilance Test Form1467-Psychomotor Vigilance Testing.pptx.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Study Subset for Additional Collection	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	1466	Sleep diary	Form1466-PaperSleepDiary.docx		No		Paper Only
Form and Instruction	1467	Psychomotor Vigilance Test	Form1467-Psychomotor Vigilance Testing.pptx.pdf		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	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	30	30
Annual IC Time Burden (Hours)	124	124
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.