Information Collection

Study Questionnaire Series

IC 278283 under ICR 202512-2127-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form 2018 Screening Questionnaire Study Questionnaire Series	Form and Instruction
Form Form 2019 Informed Consent Study Questionnaire Series	Form and Instruction
Form Form 2020 Pre-Study Questionnaire Study Questionnaire Series	Form and Instruction
Form Form 2021 Post-Study Questionnaire Study Questionnaire Series	Form and Instruction
Form 2018 Screening Questionnaire FactorsThatInfluenceEffectiveness_Screening Questionnaire_Form 2018_12.3.2025.docx	Form and Instruction
Form 2019 Informed Consent FactorsThatInfluenceEffectiveness_Form 2019_ConsentForm_12.3.2025.docx	Form and Instruction
Form 2020 Pre-Study Questionnaire FactorsThatInfluenceEffectiveness_Pre-Study Questionnaire_Form 2020_12.3.2025.docx	Form and Instruction
Form 2021 Post-Study Questionnaire FactorsThatInfluenceEffectiveness_Post-Study Questionnaire_Form 2021_12.3.2025.docx	Form and Instruction

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form 2018	Yes	Yes	Fillable Fileable
Form and Instruction	Form 2019	Yes	Yes	Fillable Fileable
Form and Instruction	Form 2020	Yes	Yes	Fillable Fileable
Form and Instruction	Form 2021	Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 334

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	334	334
Annual IC Time Burden (Hours)	322	322
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.

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