United States Department of Transportation National Highway Traffic Safety Administration |
SUPPLEMENTALMAIL BACK FORM(04/14/10 Draft) |
Form Approved O.M.B. No. 2127-0626 Expiration Date: XXXX
National Automotive Sampling System Tire Pressure Monitoring System – Special Study |
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 2127-0626. Public reporting for this collection of information is estimated to be approximately 10 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. NHTSA Form 1066
Official Use Only
Primary Sampling Unit Number
___ ___
Date of Observation
___ ___ / ___ ___ / 2010
SUP ID ___ ___ ___ ___ ___
___ ___ ___ ___ ___
Site
Number
____________________
Observation
Number ___ ___
Some TPMS have both a warning lamp to indicate low tire pressure and a malfunction lamp to indicate the TPMS is not working properly. Other TPMS have a combined warning and malfunction lamp. Does your TPMS have a:
Warning Lamp No Yes Don’t Know
Malfunction Lamp No Yes Don’t Know
Combined Warning and Malfunction Lamp
No Yes Don’t Know
IF RESPONSE TO QUESTION #6.1 or 6.3 IS “YES”, CONTINUE; IF NOT, SKIP TO QUESTION #15
[Questions on TPMS Low Pressure Warning Lamp]
Do you know where your TPMS warning (combined) lamp is located? If yes, where? (Check one)
No
Yes, on instrument panel
Yes, on rearview mirror
Yes, roof console
Yes, other (specify) ___________________
Has your TPMS warning (combined) lamp ever illuminated except during engine on/off cycles? If yes, how many times?
No
Yes, ___ ___ (Code approx. number of times)
Yes, don’t know how many times.
Don’t know if illuminated
IF RESPONSE TO QUESTION #8 IS “YES”, CONTINUE; IF NOT, SKIP TO QUESTION #15
When was the last time the warning (combined) lamp illuminated on this vehicle?
Within the past month
1-3 months ago
4 or more months ago
Continuously/repetitively
Don’t know
What actions did you take the last time the TPMS warning (combined) lamp illuminated? (Check all that apply)
Checked tire pressure
Reset the TPMS
Took vehicle to the dealer or a service facility
Added air
Did nothing (Skip to #14)
Other (specify)_______________________
How long after you first noticed the lamp illuminated, did you take action?
During the same trip (e.g., pulled over)
Later the same day or within several days
One or more weeks after
Did any of the tires need air? If yes, how many?
No
Yes, _________ (Code number of tires)
Yes, don’t know how many tires.
Don’t know if any of tires needed air.
IF RESPONSE TO QUESTION #12 IS “YES”, CONTINUE; IF NOT, SKIP TO QUESTION #14
Approximately how much air was needed in each tire? (Estimate on average if multiple tires needed air)
Less than 5 PSI
5 to 10 PSI
10 to 15 PSI
More than 15 PSI
Don’t know
Have you or someone else checked the vehicle because the warning (combined) lamp was not working correctly? If yes, what was found to be the reason? (Check all that apply)
No, did not check it
Yes, needed re-set
Yes, sensors or other part in the tire not working
Yes, batteries needed to be changed
Yes, light bulb needed to be replaced
Yes, general problem with TPMS system
Yes, don’t know
Yes, other (specify) ______________________
-----------------------
Do you know how to reset (calibrate) your TPMS?
If yes, how do you do it? (Check one)
No
Yes, use button in vehicle
Yes, follow menu on display
Yes, only dealer/service station can do it
Yes, other (specify) ___________________
When should your TPMS be reset? (Check all that apply)
Never
When the tire pressure is checked
When the tire pressure is changed
When a tire is changed
When the tires are rotated
Don’t know
Other (specify)_______________________
How easy or difficult is it to reset your TPMS?
Very easy
Somewhat easy
Somewhat difficult
Very difficult
Don’t know
To what extent do you rely on your TPMS to tell you when your tires need air? (Check one)
Rely fully on the TPMS
Rely on TPMS, but also use other methods
Don’t rely on TPMS, only use other methods
IF RESPONSE TO QUESTION #6.2 WAS “YES”, CONTINUE; IF NOT, END INTERVIEW
[Questions on TPMS Malfunction Warning Lamp]
Do you know where your TPMS malfunction lamp is located? If yes, where? (Check one)
No
Yes, on instrument panel
Yes, on rearview mirror
Yes, roof console
Yes, other (specify) _______________
IF RESPONSE TO QUESTION #19 IS “YES”, CONTINUE; IF NOT, END INTERVIEW
Has your TPMS malfunction lamp ever illuminated, except during engine on/off cycles? If yes, how many times?
No
Yes, ___ ___ (Code approx. number of times)
Yes, don’t know how many times.
Don’t know if illuminated
IF RESPONSE TO QUESTION #20 IS “YES”, CONTINUE; IF NOT, END INTERVIEW
When was the last time the malfunction lamp illuminated on this vehicle?
Within the past month
1-2 months ago
3-4 months ago
More than 4 months ago
Continuously/repetitively
Don’t know
What actions did you take the last time the TPMS malfunction lamp illuminated? (Check all that apply)
Did nothing-it often illuminates
Did nothing-other reasons
Reset the TPMS
Took vehicle to the dealer or a service facility
Self or others worked on vehicle
Other (specify)_______________________
Have you or someone else checked the vehicle because the malfunction lamp was not working correctly? If yes, what was found to be the reason? (Check all that apply)
No, did not check it
Yes, needed re-set
Yes, sensors or other part in the tire not working
Yes, batteries needed to be changed
Yes, light bulb needed to be replaced
Yes, general problem with TPMS system
Yes, don’t know
Yes, other (specify) __________________
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 XX 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. NHTSA Form 1060
File Type | application/msword |
File Title | How many years have you had this vehicle |
Author | kirk.allen |
Last Modified By | charlene.doyle |
File Modified | 2010-06-02 |
File Created | 2010-05-19 |