Evaluation Surveys for Impaired Driving and Safety Belt Interventions

Forms and Documents

Document Name	Status
Form NHTSA 1012 Click It or Ticket Next Generation Surveys Form	New
IC 2127-0646 Justification for Nonsubstantial Change.doc Justification for No Material/Nonsubstantive Change	2007-06-29
OMB 2127-0646 Submission For Demo Project Surveys[1].DOC Supplementary Document	2006-02-23
2127-0646 Part B[1].DOC Supporting Statement B	0000-00-00
2127-0646 Part A[1].DOC Supporting Statement A	0000-00-00

IC Document Collections

IC ID	Document Title	Status
180957	Click It or Ticket Next Generation Surveys Form	New

ICR Details

OMB Control No: 2127-0646	ICR Reference No: 200706-2127-005
Status: Historical Active	Previous ICR Reference No: 200702-2127-003
Agency/Subagency: DOT/NHTSA	Agency Tracking No:
Title: Evaluation Surveys for Impaired Driving and Safety Belt Interventions
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/05/2008
	Date Received in OIRA: 02/29/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2008	06/30/2008	06/30/2008
Responses	84,000	0	24,000
Time Burden (Hours)	14,000	0	4,000
Cost Burden (Dollars)	6,720	0	1,920

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Abstract: These are pre/post telephone surveys to evaluate safety belt mobilizations, impaired driving mobilizations, and belt/alcohol demonstration projects. National, State, and local samples will be used. The terms of clearance further stated that OMB will review the complete specification of each State/Demonstration survey instance within in 15 business days. This request for generic approval contains those State/Demonstrations surveys.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	70 FR 72500	12/05/2005
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 9858	02/27/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Click It or Ticket Next Generation Surveys	NHTSA 1012, NHTSA 1012, NHTSA 1012	Iowa Seat Belt Survey ,   Pennsylvania Seat Belt Survey ,   Virginia Seat Belt Survey

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	84,000	24,000	0	0	60,000	0
Annual Time Burden (Hours)	14,000	4,000	0	0	10,000	0
Annual Cost Burden (Dollars)	6,720	1,920	0	0	4,800	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: These changes are reflective only of the generic clearance instance of the surveys. Additional burden is needed due to changes in NHTSA programs and Evaluation of these Programs. Specifically, we will be testing different media flights for different media markets within States. This requires us to survey at the level of media markets rather than the State level for our demonstration programs. Since there are several media markets within each State, this has increased our need for more respondents.

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Annual Cost to Federal Government: $576,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/29/2008

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