Information Collection

Eligibility Questionnaire

IC 256174 under ICR 202209-2127-004 · OMB 2127-0765.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NHTSA Form 1624 Eligibility Questionnaire	Form
NHTSA Form 1624 Eligibility Questionnaire Seat Preference Study Draft Eligibility Questionnaire_2022-02-23 clean.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 1624	Eligibility Questionnaire	Seat Preference Study Draft Eligibility Questionnaire_2022-02-23 clean.docx		No		Paper Only

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	67	67
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.