Information Collection

Form 2076 Intake Procedures (Eligibility Confirmation, Daily Heath Survey, Simulator Familiarization Drive)

IC 281943 under ICR 202606-2127-003 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2076 Intake Procedures (Eligibility Confirmation, Daily Heath Survey, Simulator Familiarization Drive) Form 2076 Intake Procedures (Eligibility Confirmation, Daily Heath Survey, Simulator Familiarization Drive)	Form
2076 Intake Procedures (Eligibility Confirmation, Daily Heath NHTSA Form 2076 Daily Health Survey.docx	Form

IC Title:

Agency IC Tracking Number:

IC Status: New

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	2076				Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 178

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	178	178
Annual IC Time Burden (Hours)	62	62
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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