Information Collection

Appendix B - Online Survey Pre-Screener

IC 236370 under ICR 201905-2127-007 · OMB 2127-0745.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NHTSA 1393 Appendix B - Online Survey Pre-Screener	Form
NHTSA 1393 Appendix B - Online Survey Pre-Screened Appendix B - Online Survey Pre-Screener_OMB_9.4.2019_Clean.docx	Form

IC Title:

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NHTSA 1393	Appendix B - Online Survey Pre-Screened	Appendix B - Online Survey Pre-Screener_OMB_9.4.2019_Clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 18,520

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	18,520	18,520
Annual IC Time Burden (Hours)	463	463
Annual IC Cost Burden (Dollars)	0	0

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.