Appendix I - Cognitive Pre-Screener

Supporting Statement for New Car Assessment Program (NCAP) Communications Research Quantitative ICR Package

Documents and Forms

Document Name Document Type
Form NHTSA 1391 Appendix I - Cognitive Pre-Screener Form
NHTSA 1391 Appendix I - Cognitive Pre-Screener Appendix I - Cognitive Pre-Screener -5-21-19 (003).docx Form

Information Collection (IC) Details

IC Title:	Appendix I - Cognitive Pre-Screener	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	NHTSA 1391	Appendix I - Cognitive Pre-Screener	Appendix I - Cognitive Pre-Screener -5-21-19 (003).docx		No		Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	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	600	600
Annual IC Time Burden (Hours)	15	15
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.