Information Collection

State Website (user access only)

IC 238343 under ICR 202601-2127-001 · OMB 2127-0714.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NHTSA Form 1696 Crash Report Sampling System Form State Website (user access only)	Form
Form NHTSA Form 2174 NTS Data Entry Form State Website (user access only)	Form
NHTSA Form 1696 Crash Report Sampling System Form RBIS CRSS 2022_Dec192022.pdf	Form
NHTSA Form 2174 NTS Data Entry Form 2025 NTS Case Entry Form.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 49 CFR 501.1

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 1696				Yes	Yes	Fillable Fileable
Form	NHTSA Form 2174				Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 76 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	12	1	11
Annual IC Time Burden (Hours)	120	10	110
Annual IC Cost Burden (Dollars)	0	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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