Information Collection

Eligible Respondents Who Report Harrassment or Assault

IC 240695 under ICR 202003-2126-002 · OMB 2126-0071.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2126-0071 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form 2 Eligible Respondents Who Report Harrassment or Assault	Form and Instruction
Form 2 Survey on Crime Prevention for Truckers TruckerCrimesQuestions.docx	Form and Instruction

IC Title:

Eligible Respondents Who Report Harrassment or Assault

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 and Instruction	Form 2	Survey on Crime Prevention for Truckers	TruckerCrimesQuestions.docx		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 800

Number of Respondents for Small Entity: 500

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 82 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	267	267
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.