Driver Exercise and Food Consumption Questionnaire

Evaluation of the Effectiveness of the Training and Education Modules in the North American Fatigue Management Program

Documents and Forms

Document Name Document Type
Driver Exercise and Food Consumption Questionnaire Form and Instruction
Exercise and Food Consumption Questionnaire Att. N Exercise and Food Consumption Questionnaire.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Driver Exercise and Food Consumption Questionnaire	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	n/a	Exercise and Food Consumption Questionnaire	Att. N Exercise and Food Consumption Questionnaire.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 90	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	360	360
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	2,580	2,580

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.