Eligibility/Demographic Interview

Driver Alcohol Detection System for Safety Field Operational Test (DADSS-FOT)

Documents and Forms

Document Name Document Type
Form NHTAS Form 1647 Eligibility/Demographic Interview Form
NHTAS Form 1647 Eligibility Demographic Questionnaire PRA_DADSS_FOT_Eligibility Demographic Questionnaire.docx Form
NHTAS Form 1647 Eligibility Demographic Questionnaire PRA_DADSS_FOT_Eligibility Demographic Questionnaire.docx Form

Information Collection (IC) Details

IC Title:	Eligibility/Demographic Interview	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	NHTAS Form 1647	Eligibility Demographic Questionnaire	PRA_DADSS_FOT_Eligibility Demographic Questionnaire.docx		No		Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,393	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	1,393	1,393
Annual IC Time Burden (Hours)	697	697
Annual IC Cost Burden (Dollars)	0	0

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.