NHTSA Form 1075

OMB No. 2127-XXXX

Expiration Date: mm/dd/yyyy

Survey of Consumer Response to
CARS Initiative

(Commonly known as 'Cash for Clunkers')

Please answer the following 3 questions regarding your trade-in transaction. Your answers are for program evaluation purposes only and will not influence your eligibility in any way. Please put an X in the box by the appropriate answer.

Question #1: If you were not offered the CARS program trade-in incentive, would you still have traded in your current vehicle to purchase a new or used vehicle this month?

 a) Yes

 b) No

If no, when were you planning to trade-in, sell or dispose of your vehicle?

Within the next year	4 years	8 years
In about 1 year	5 years	9 years
2 years 3 years	6 years 7 years	10 years More than 10 years

Question # 2: If you were not offered the CARS program trade-in incentive, when you disposed of this vehicle, would you have purchased another vehicle?

 a) No

 b) Yes, a new vehicle (Please select one type below)

 c) Yes, a used vehicle (Please select one type below)

 a) a subcompact car (for example a Honda Fit, or a Toyota Yaris, etc.)

 b) a compact car (ex. Ford Focus, Nissan Sentra, Toyota Corolla, Honda Civic, etc.)

 c) a mid-sized car (ex. Chevrolet Malibu, Nissan Altima, Toyota Camry, etc.)

 d) a large car (ex. Chrysler 300, Ford Crown Victoria, etc.)

 e) a small SUV (ex. Honda CR-V, Ford Escape, etc.)

 f) a mid-sized SUV (ex. Ford Explorer, Honda Pilot, etc.)

 g) a large SUV (ex. Chevrolet Suburban, Ford Expedition, etc.)

 h) a small pickup (ex. Ford Ranger, etc.)

 i) a mid-sized pickup (ex. Dodge Dakota, Toyota Tacoma, etc.)

 j) a large pickup (ex. Chevrolet Silverado, Ford F-150, etc.)

 k) a full sized passenger van (ex. Ford E-Series, Chevrolet Express, etc.)

 l) a full sized cargo van (ex. Chevrolet Express, Dodge Sprinter, etc.)

 m) a mini-van (ex. Toyota Sienna, Dodge Caravan, etc.)

 n) other type (specify) ________________

Question #3: What is your best estimate of the number of miles you drove the traded-in vehicle during the past 12 months?

0 – 2,499	7,500 – 9,999	15,000 – 17,499
2,500 – 4,999	10,000 – 12,499	17,500 – 19,999
5,000 – 7,499	12,500 – 14,999	20,000 or more

.

NHTSA Form 1075

Paperwork Reduction Act Burden Statement

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-XXXX. Public reporting for this collection of information is estimated to be approximately 3 minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590.

Thank you for participating in the CARS Initiative Consumer Response Survey!

Please contact the CARS Hotline at (866)-CAR-7891 or TTY at (800)-424-9153 if you wish to provide any comments

NHTSA Form 1075