Information Collection

Screening Questionnaire

IC 242745 under ICR 202007-2127-001 · OMB 2127-0751.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NHTSA Form 1523 Screening Questionnaire	Form
NHTSA Form 1523 Screening Questionnaire NHTSA Form 1523_Screening Questionnaire_ALL APPROVED_Revised HeaderFooter (002).docx	Form
NHTSA Form 1523 Screening Questionnaire NHTSA Form 1523_Screening Questionnaire_ALL APPROVED_Revised HeaderFooter (002).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 Form 1523	Screening Questionnaire	NHTSA Form 1523_Screening Questionnaire_ALL APPROVED_Revised HeaderFooter (002).docx		Yes	Yes	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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	70	70
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.