Form NHTSA Form 1522 NHTSA Form 1522 Driver Research Study Interest Response Form

STUDY: Research on Passenger Car Driver Interactions with Driver Assistance Technologies

STERLING IRB ID: 7780-EMazzae

DATE OF IRB REVIEW: 02/03/20

OMB Control Number: 2127-NEW

Expiration Date: XX/XX/XXXX

Approved by Sterling IRB, IRB ID: 7780

Driving Research Study Interest Response Form

U.S. Department of Transportation National Highway Traffic Safety Administration

This collection of information is voluntary and will be used to determine your eligibility for study participation. Respondent burden is estimated to average 5 minutes.

Any data collected relating to this study that personally identifies you or that could be used to personally identify you will be treated with confidentiality. Contact information data will be stored on password-protected directories and destroyed after the study is complete.

Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is XXXX-XXXX. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Avenue, SE, Washington, DC 20590.

Do you have a valid U.S. driver license? *

• Yes  No

If your license has restrictions, please list:

Sex: * Age (years): *

• Male  Female

How many miles do you typically drive per year? *

Less than	3,000 –	7,000 –	10,000 –	14,000 –	21,000 or
3,000 miles	6,999 miles	9,999 miles	13,999 miles	20,999 miles	more miles

How many days per week do you typically drive? *

0-1 days

2-4 days

5-7 days

How many days per week do you find yourself driving on a multi-lane highway (at least 2 lanes in each direction)? *

0-1 days

2-4 days

5-7 days

What is the make, model, and model year of your current primary vehicle? *

Make/Model

Model Year

What is the trim level of your vehicle? *

Trim Level

If other, list the make/model:

Which of the following advanced driver-assist features is your vehicle equipped with? *

GM Super Cruise	Adaptive Cruise Control
Lane Keeping Assist	Blind Spot Warning
None	Other:

How many miles have you driven with this particular vehicle? *

1 – 4,999	5,000 –	10,000 –	15,000 –	14,000 –	20,000+
	9,999	14,999	13,999	19,999

Approximately how many of those miles have you driven while using Adaptive Cruise Control and/or Lane Keeping Assist?

1 – 2,499	2,500 –	5,000 –	7,500 –	10,000 –	12,500 –	15,001+
	4,999	7,499	9,999	12,499	15,000

If your vehicle is not equipped with Adaptive Cruise Control and/or Lane Keeping Assist, have you ever driven a vehicle equipped with these features?

Yes

No

Not sure

If you have driven a vehicle equipped with Adaptive Cruise Control and/or Lane Keeping Assist, how much experience would you say you have in using these features? *

No experience

A little experience

Some experience

A lot of experience

Name *

First

MI

Last

Address

Street Address

City

Zip

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E-mail address: * Phone Number: *

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How did you learn about our study? *

TRC Website Online Ad	Facebook Ad
Newspaper Website Online Ad	Newspaper Print Ad
Friend or Relative	Other (Please specify

):

Submit

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