Information Collection

Task 4 - Pre-study Demographics & Previous Experiences questionnaire

IC 261954 under ICR 202308-2126-001 · OMB 2126-0083.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2126-0083 can be found here:

Documents and Forms

Document Name Document Type
Form Form No. 4 Task 4 - Pre-study Demographics & Previous Experiences questionnaire Form and Instruction
Form No. 4 Questionnaire #1 – Pre-Study Demographic/Previous Experi Attachment G - Data Collection Materials_3.29.24_Clean.docx Form and Instruction
Form No. 4 Questionnaire #1 – Pre-Study Demographic/Previous Experi Attachment G - Data Collection Materials_3.29.24_Clean.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Task 4 - Pre-study Demographics & Previous Experiences questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 49 CFR 1.87

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form No. 4	Questionnaire #1 â Pre-Study Demographic/Previous Experiences	Attachment G - Data Collection Materials_3.29.24_Clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 88	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	88	88
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.