Experiment Form

Fatal Crash Seat Belt Use Reporting and Awareness

Documents and Forms

Document Name Document Type
Form 1601 Experiment Form Form and Instruction
1601 Experiment Form Form 1601_Experiment Form_Fatal Crash project 012522 (1).docx Form and Instruction
1601 Experiment Form Form 1601_Experiment Form_Fatal Crash project 012522 (1).docx Form and Instruction

Information Collection (IC) Details

IC Title:	Experiment Form	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	1601	Experiment Form	Form 1601_Experiment Form_Fatal Crash project 012522 (1).docx		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	14,960	14,960

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.