Screening Questionnaire

Drivers’ Knowledge and Correct Use of New Technology Features in Passenger Vehicles

Documents and Forms

Document Name Document Type
Form 1627 Screening Questionnaire Form and Instruction
1627 Screening Questionnaire ADAS ICR Form 1627 Screening 111921-asg RAA.docx Form and Instruction
1627 Screening Questionnaire ADAS ICR Form 1627 Screening 111921-asg RAA.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Screening Questionnaire	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	1627	Screening Questionnaire	ADAS ICR Form 1627 Screening 111921-asg RAA.docx		Yes	No	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	7,230	7,230

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.