Information Collection

Older Driver Rearview Video Systems Informed Consent

IC 228912 under ICR 202303-2127-002 · OMB 2127-0731.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1399 Older Driver Rearview Video Systems Informed Consent	Form and Instruction
1399 Informed Consent Older Driver Rearview Video Systems ICR Form 1399.docx	Form and Instruction
1399 Informed Consent Older Driver Rearview Video Systems ICR Form 1399.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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 and Instruction	1399	Informed Consent	Older Driver Rearview Video Systems ICR Form 1399.docx		Yes	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
	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-200	200
Annual IC Time Burden (Hours)	-335	335
Annual IC Cost Burden (Dollars)	-8,322	8,322

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.