Impact Analysis Questions

Impact Analysis

Page #1

PAPERWORK REDUCTION ACT PUBLIC BURDEN STATEMENT
According to the Paperwork Reduction Act of 1995, 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 unless it displays a current
valid OMB control number. The valid OMB control number for this information collection is 2137-0034. The information requested on
this form is being collected by the U.S. Department of Transportation, Pipeline and Hazardous Materials Safety Administration
(PHMSA). Public reporting burden for this collection of information is estimated to be 60 minutes per response, including time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. All responses to this collection are voluntary. Send comments regarding this burden estimate or any
other aspect of the collection of information, including suggestions for reducing this burden, to: Mr. T. Glenn Foster, Information
Collection Clearance Officer, U. S. Department of Transportation, PHMSA, Office of Hazardous Materials Safety, PHH-10, 1200
New Jersey Ave., S.E., 2nd Floor East, E24-301, Washington, DC 20520.

Page #2
Branching Information
   • If not 11. Does your agency/company/organization current... = Yes then Hide 11a. Can this data be accessed in real-time (i.e....
   • If 11. Does your agency/company/organization current... is one of [u'1', u'2', u'3'] then Hide 11a. Can this data be accessed in
real-time (i.e....
 1. Name of the agency/company/organization you are representing:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
 2. Location of the agency/company/organization:
Town or City:

______________________

County:

______________________

State:

______________________

Zip Code:

______________________

 3. Point of Contact (POC) information for the person completing this questionnaire:
Name:

______________________

Title:

______________________

Address:

______________________

Phone:

______________________

Email:

______________________

 4. Which category(ies) describe your agency/company/organization? Select all that apply:
 Hazardous materials (HM) shipper
 HM carrier
 Emergency responder
 HM inspector
 Federal government
 State government
 Local government
 HM equipment vendor
 HM/emergency response training vendor/consultant
 Other, please identify: __________________________
 5. With what transportation mode(s) does your agency/company/organization interact? Select all that apply:
 Roadway (truck)
 Rail
 Air
 Maritime (vessel)
 Not applicable
 6. Describe the size of your agency/company/organization using any of the following parameters:
 Small
 Medium
 Large
 Number of HM shipments annually: __________________________
 Annual revenue (in U.S. dollars): __________________________
 Number of employees: __________________________

 Other, please identify: __________________________
 7. Does your agency/company/organization perform domestic (i.e., within the U.S.) commerce?
 Yes
 No
 Unknown
 Not applicable
 8. Does your agency/company/organization perform international commerce?
 Yes
 No
 Unknown
 Not applicable
 9. Does your agency/company/organization belong to any chemical and/or transportation industry associations?
 Yes, please provide association name(s): __________________________
 No
 Unknown
 10. Are personnel at your agency/company/organization familiar with the look and content of an HM shipping paper?
 Yes
 No
 Unknown
 11. Does your agency/company/organization currently have electronic access to conveyance (i.e., truck, railcar, plane, or
vessel) HM data satisfying the U.S. Department of Transportation (DOT) shipping paper requirements?
 Yes
 No
 Unknown
 Not applicable
 11a. Can this data be accessed in real-time (i.e., within five minutes of recall)?
 Yes
 No
 Unknown

Page #3
 12. Do you understand that PHMSA will use the information you provide in this questionnaire as part of PHMSA’s public report
to Congress, Federal agencies, and other stakeholders, in support of the Moving Ahead for Progress in the 21st Century Act
(MAP-21)?
 Yes
 No

Page #4
Branching Information
   • If 13. What class(es) of HM does your agency/company... contains one of [u'0', u'1', u'2', u'3', u'4', u'5', u'6', u'7', u'8', u'9'] then
Skip to Page 5
   • If 13. What class(es) of HM does your agency/company... = [u'10'] then Skip to Page 7
 13. What class(es) of HM does your agency/company/organization transport? Please select all that apply:
 Class 1 Explosives
 Class 2 Gases
 Class 3 Flammable Liquids (100°F or less, closed cup)
 Class 4 Other Flammable Substances
 Class 5 Oxidizing Substances and Organic Peroxides
 Class 6 Toxic (Poisonous) and Infectious Substances
 Class 7 Radioactive Materials
 Class 8 Corrosives
 Class 9 Miscellaneous Dangerous Materials
 Unknown
 Not applicable, my agency/company/organization does not transport HM

Page #5
Branching Information
   • If not 16. Does your agency/company/organization interac... = Yes then Hide 16a. Which mode(s) does your
agency/company/organ...
   • If 16. Does your agency/company/organization interac... is one of [u'1', u'2', u'3'] then Hide 16a. Which mode(s) does your
agency/company/organ...
   • If not 19. How are your HM shipments packaged? Please s... contains Non-bulk packaging then Hide 19a. Which types of
non-bulk HM packaging are use...
   • If not 19. How are your HM shipments packaged? Please s... contains Bulk packaging then Hide 19b. Which types of bulk HM
packaging are used? ...
   • If not 19. How are your HM shipments packaged? Please s... contains Radioactive HM packaging then Hide 19c. Which types of
radioactive HM packaging are ...
 14. By what mode(s) does your agency/company/organization transport HM? Please select all that apply:
 Roadway (truck)
 Rail
 Air
 Maritime (vessel--domestic)
 Maritime (vessel--international)
 Unknown
 15. For each mode used to transport HM shipments, does your agency/company/organization utilize your own equipment and
personnel or contractor resources?
15a.  Roadway:
 Agency/company/organization equipment and personnel
 Contractor resources
 Both agency/company/organization equipment and personnel AND contractor resources
 Unknown
 Not applicable, my agency/company/organization does not transport HM via roadways
 15b.  Rail:
 Agency/company/organization equipment and personnel
 Contractor resources
 Both agency/company/organization equipment and personnel AND contractor resources
 Unknown
 Not applicable, my agency/company/organization does not transport HM via rail
 15c.  Air:
 Agency/company/organization equipment and personnel
 Contractor resources
 Both agency/company/organization equipment and personnel AND contractor resources
 Unknown
 Not applicable, my agency/company/organization does not transport HM via air
 15d.  Maritime (domestic):
 Agency/company/organization equipment and personnel
 Contractor resources
 Both agency/company/organization equipment and personnel AND contractor resources
 Unknown
 Not applicable, my agency/company/organization does not transport HM via maritime (domestic)
 15e.  Maritime (international):
 Agency/company/organization equipment and personnel
 Contractor resources

 Both agency/company/organization equipment and personnel AND contractor resources
 Unknown
 Not applicable, my agency/company/organization does not transport HM via maritime (international)
 16. Does your agency/company/organization interact with intermodal carriers for HM transfers?
 Yes
 No
 Unknown
 Not applicable
 16a. Which mode(s) does your agency/company/organization interact with for intermodal HM transfers? Please select all that
apply:
 Roadway (truck)
 Rail
 Air
 Maritime (vessel)
 Unknown
 17. Does your agency/company/organization transport less than truckload (LTL) HM shipments?
 Yes
 No
 Unknown
 Not applicable, my agency/company/organization does not transport HM via roadways
 18. Approximately how much HM does your agency/company/organization transport annually? Please report this information in
at least one of the following measurements:
 Tons per year: __________________________
 Ton miles per year: __________________________
 Number of shipments per week: __________________________
 Number of shipments per month: __________________________
 Number of shipments per year: __________________________
 Number of twenty-foot equivalent unit (TEU) containers per week: __________________________
 Number of TEU containers per month: __________________________
 Number of TEU containers per year: __________________________
 Other, please identify: __________________________
 Unknown

Page #6
Branching Information
   • If not 19. How are your HM shipments packaged? Please s... contains Non-bulk packaging then Hide 19a. Which types of
non-bulk HM packaging are use...
   • If not 19. How are your HM shipments packaged? Please s... contains Bulk packaging then Hide 19b. Which types of bulk HM
packaging are used? ...
   • If not 19. How are your HM shipments packaged? Please s... contains Radioactive HM packaging then Hide 19c. Which types of
radioactive HM packaging are ...
   • If not 22. Does your agency/company/organization use HM ... = Yes then Hide 22a. For what purpose(s)? Please select all that...
   • If 22. Does your agency/company/organization use HM ... is one of [u'1', u'2', u'3'] then Hide 22a. For what purpose(s)? Please
select all that...
 19. How are your HM shipments packaged? Please select all that apply:
 Non-bulk packaging
 Bulk packaging
 Radioactive HM packaging
 19a. Which types of non-bulk HM packaging are used? Please select all that apply:
 Drums/pails
 Jerricans
 Barrels
 Boxes
 Bags
 Cylinders
 Other, please identify: __________________________
 19b. Which types of bulk HM packaging are used? Please select all that apply:
 Cargo tanks
 Tank cars (rail)
 Intermediate bulk containers (IBCs)/portable tanks
 Freight containers
 Other, please identify: __________________________
 19c. Which types of radioactive HM packaging are used? Please select all that apply:
 Type A
 Type B
 Industrial
 Excepted, please identify: __________________________
 20. On average, how long does it take to complete a hardcopy HM shipping paper?
 Less than 5 minutes
 5 to 10 minutes
 11 to 15 minutes
 16 to 30 minutes
 31 to 60 minutes
 One to two hours
 Two to three hours
 More than three hours, identify time: __________________________
 Unknown
 21. On average, how long does it take to complete an e-shipping paper?
 Less than 5 minutes
 5 to 10 minutes
 11 to 15 minutes
 16 to 30 minutes

 31 to 60 minutes
 One to two hours
 Two to three hours
 More than three hours, identify time: __________________________
 Unknown
 Not applicable
 22. Does your agency/company/organization use HM shipping papers for purposes other than regulatory?
 Yes
 No
 Unknown
 22a. For what purpose(s)? Please select all that apply:
 Delivery receipt/confirmation
 Driver/pilot/captain/conductor pay record information
 Trip log
 Other, please identify: __________________________
 Unknown

Page #7
Branching Information
   • If not 24. In your opinion, what HM information is <stron... contains one of [u'0', u'1', u'2', u'3', u'4', u'5', u'6', u'7', u'8', u'9', u'10',
u'11', u'12', u'13', u'14', u'15', u'16', u'17', u'18', u'19', u'20', u'21', u'22', u'23', u'24', u'25'] then Hide 24a. What is the longest
timeframe that is accepta...
   • If 24. In your opinion, what HM information is <stron... = [u'26'] then Hide 24a. What is the longest timeframe that is accepta...
   • If not 24b. Can you think of any additional HM informatio... = Yes, please describe: then Hide 24c. What is the longest timeframe
that is accept...
   • If 24b. Can you think of any additional HM informatio... = No then Hide 24c. What is the longest timeframe that is accept...
   • If not 25. In your opinion, what HM information is <stron... contains one of [u'0', u'1', u'2', u'3', u'4', u'5', u'6', u'7', u'8', u'9', u'10',
u'11', u'12', u'13', u'14', u'15', u'16', u'17', u'18', u'19', u'20', u'21', u'22', u'23', u'24', u'25'] then Hide 25a. What is the longest
timeframe that is accepta...
   • If 25. In your opinion, what HM information is <stron... = [u'26'] then Hide 25a. What is the longest timeframe that is accepta...
   • If not 25b. Can you think of any additional HM informatio... = Yes, please describe: then Hide 25c. What is the longest timeframe
that is accepta...
   • If 25b. Can you think of any additional HM informatio... = No then Hide 25c. What is the longest timeframe that is accepta...
   • If not 26. Has your agency/company/organization ever use... = Yes then Hide 26a. Please describe the inspection(s) and or inc...
   • If not 26. Has your agency/company/organization ever use... = Yes then Hide 26b. What means was used to provide the HM
inform...
   • If not 26. Has your agency/company/organization ever use... = Yes then Hide 26c. How quickly was the information provided to ...
   • If 26. Has your agency/company/organization ever use... is one of [u'1', u'2', u'3'] then Hide 26a. Please describe the
inspection(s) and or inc...
   • If 26. Has your agency/company/organization ever use... is one of [u'1', u'2', u'3'] then Hide 26b. What means was used to
provide the HM inform...
   • If 26. Has your agency/company/organization ever use... is one of [u'1', u'2', u'3'] then Hide 26c. How quickly was the information
provided to ...
   • If not 27. Has your agency/company/organization ever rec... = Yes then Hide 27a. What entity(ies) provided the HM information...
   • If not 27. Has your agency/company/organization ever rec... = Yes then Hide 27b. What HM information was provided? Please
se...
   • If 27. Has your agency/company/organization ever rec... is one of [u'1', u'2', u'3'] then Hide 27a. What entity(ies) provided the HM
information...
   • If 27. Has your agency/company/organization ever rec... is one of [u'1', u'2', u'3'] then Hide 27b. What HM information was
provided? Please se...
 23. Does your agency/company/organization utilize an outside company to assist with HM information and emergency response
communication?
 Yes, please identify: __________________________
 No
 Unknown
 Not applicable
 24. In your opinion, what HM information is essential for emergency responders to receive to assess the hazards and to properly
respond to an HM incident after arriving at the emergency site? Please select all that apply:
 Air Waybill Number
 Basic description of the HM
 Technical name of the HM
 Proper shipping name
 Immediate hazards to health
 Risks of fire or explosion
 Immediate precautions to be taken in an accident or incident
 Immediate methods for handling fires, spills, or leaks
 Preliminary first aid measures
 Emergency response assistance plan (ERAP) reference number
 24-hour emergency response telephone number
 Ability of the operator to contact the carrier in an incident involving HM
 UN identification number

 Hazard class or division number
 Packing group
 Tunnel restriction code
 Total quantity of material
 Number and type of packages
 Name and address of the consignor (i.e., shipper)
 Name and address of the consignee (i.e., receiver)
 Date shipping document was prepared or first given to a shipper
 Shipper's statement or supplementary requirements for loading, stowage, carriage, handling, and unloading, including any
special stowage provisions
 Shipper's restrictions on the mode of transport and any necessary routing instructions
 Shipper's signed certification statement
 Hazardous Waste Manifest (when necessary)
 Other, please identify: __________________________
 Unknown
 24a. What is the longest timeframe that is acceptable for receipt of the essential information?
 Instantaneous
 5 minutes or less
 6 to 15 minutes
 16 to 30 minutes
 31 minutes to one hour
 24b. Can you think of any additional HM information that may be helpful for emergency responders to receive after arriving at
the emergency site?
 Yes, please describe: __________________________
 No
 24c. What is the longest timeframe that is acceptable for receipt of this additional information?
 Instantaneous
 Within 15 minutes of request
 16 to 30 minutes from original request
 31 minutes to one hour from original request
 One to two hours from original request
 Other, please identify: __________________________
 25. In your opinion, what HM information is essential for inspectors to receive to properly conduct an HM inspection? Please
select all that apply:
 Air Waybill Number
 Basic description of the HM
 Technical name of the HM
 Proper shipping name
 Immediate hazards to health
 Risks of fire or explosion
 Immediate precautions to be taken in an accident or incident
 Immediate methods for handling fires, spills, or leaks
 Preliminary first aid measures
 Emergency response assistance plan (ERAP) reference number
 24-hour emergency response telephone number
 Ability of the operator to contact the carrier in an incident involving HM
 UN identification number
 Hazard class or division number
 Packing group
 Tunnel restriction code
 Total quantity of material
 Number and type of packages
 Name and address of the consignor (i.e., shipper)

 Name and address of the consignee (i.e., receiver)
 Date shipping document was prepared or first given to a shipper
 Shipper's statement or supplementary requirements for loading, stowage, carriage, handling, and unloading, including any
special stowage provisions
 Shipper's restrictions on the mode of transport and any necessary routing instructions
 Shipper's signed certification statement
 Hazardous Waste Manifest (when necessary)
 Other, please identify: __________________________
 Unknown
 25a. What is the longest timeframe that is acceptable for receipt of the essential information?
 Immediately
 Within 15 minutes of request
 16 to 30 minutes from original request
 31 minutes to one hour from original request
 One to two hours from original request
 Two to four hours from original request
 Four to eight hours from original request
 One day from original request
 One week from original request
 Other, please identify: __________________________
 25b. Can you think of any additional HM information that may be helpful for inspectors to receive?
 Yes, please describe: __________________________
 No
 25c. What is the longest timeframe that is acceptable for receipt of this additional information?
 Immediately
 Within 15 minutes of request
 16 to 30 minutes from original request
 31 minutes to one hour from original request
 One to two hours from original request
 Two to four hours from original request
 Four to eight hours from original request
 One day from original request
 One week from original request
 Other, please identify: __________________________
 26. Has your agency/company/organization ever used wireless or electronic communication to provide law enforcement or
emergency response personnel with HM information for an HM shipment involved in an inspection or incident?
 Yes
 No
 Unknown
 Not applicable
 26a. Please describe the inspection(s) and or incident(s):
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
 26b. What means was used to provide the HM information to law enforcement personnel/emergency responders? Please select
all that apply:
 Personal digital assistants (PDAs)
 Vehicle laptops
 Workplace computers
 Computer aid dispatch (CAD) terminals

 Home computers
 Landline telephones
 Cellular telephones
 Smartphones
 Videos
 Facsimile (FAX) machines
 Live web cameras
 Pagers
 Two-way radios
 Walkie-talkies
 Tablets
 Other, please identify: __________________________
 Unknown
 26c. How quickly was the information provided to law enforcement personnel/emergency responders?
 Instantaneous
 5 minutes or less
 6 to 15 minutes
 16 to 30 minutes
 31 minutes to one hour
 More than one hour, identify time: __________________________
 27. Has your agency/company/organization ever received wireless or electronic communication of HM information for an HM
shipment involved in an inspection or incident?
 Yes
 No
 Unknown
 Not applicable
 27a. What entity(ies) provided the HM information? Please select all that apply:
 Shipper
 carrier
 Driver/pilot/captain/conductor of the transportation conveyance
 PSAP dispatcher
 Police
 Fire personnel
 EMS personnel
 Inspection personnel
 Other, please identify: __________________________
 Unknown
 27b. What HM information was provided? Please select all that apply:
 Air Waybill Number
 Basic description of the HM
 Technical name of the HM
 Proper shipping name
 Immediate hazards to health
 Risks of fire or explosion
 Immediate precautions to be taken in an accident or incident
 Immediate methods for handling fires, spills, or leaks
 Preliminary first aid measures
 Emergency response assistance plan (ERAP) reference number
 24-hour emergency response telephone number
 Ability of the operator to contact the carrier in an incident involving HM
 UN identification number
 Hazard class or division number
 Packing group

 Tunnel restriction code
 Total quantity of material
 Number and type of packages
 Name and address of the consignor (i.e., shipper)
 Name and address of the consignee (i.e., receiver)
 Date shipping document was prepared or first given to a shipper
 Shipper's statement or supplementary requirements for loading, stowage, carriage, handling, and unloading, including any
special stowage provisions
 Shipper's restrictions on the mode of transport and any necessary routing instructions
 Shipper's signed certification statement
 Hazardous Waste Manifest (when necessary)
 Other, please identify: __________________________
 Unknown

Page #8
Branching Information
   • If not 28. Does your agency/company/organization current... = Yes then Hide 28a. POC information for your
agency's/company's/...
   • If 28. Does your agency/company/organization current... is one of [u'1', u'2', u'3'] then Skip to Page 15
   • If 28. Does your agency/company/organization current... is one of [u'1', u'2', u'3', u'4'] then Hide 28a. POC information for your
agency's/company's/...
 28. Does your agency/company/organization currently have an e-system capable of managing and communicating HM shipping
paper information?
 Yes
 No
 Unknown
 Not applicable
 28a. POC information for your agency's/company's/organization's e-system (enter "UNKNOWN" in each text field for which you
do not have a response):
Name:

______________________

Title:

______________________

Address:

______________________

Phone:

______________________

Email:

______________________

Page #9
Branching Information
   • If not 32. What type(s) of electronic data exchange langu... = Yes then Hide 32a1. What are the benefits of using this languag...
   • If not 32. What type(s) of electronic data exchange langu... = Yes then Hide 32a2. Are there any challenges or impediments
imp...
   • If 32. What type(s) of electronic data exchange langu... is one of [u'1', u'2'] then Hide 32a1. What are the benefits of using this
languag...
   • If 32. What type(s) of electronic data exchange langu... is one of [u'1', u'2'] then Hide 32a2. Are there any challenges or
impediments imp...
   • If not 32b. Universal Business Language (UBL)? = Yes then Hide 32b1. What are the benefits of using this languag...
   • If not 32b. Universal Business Language (UBL)? = Yes then Hide 32b2. Are there any challenges or impediments imp...
   • If 32b. Universal Business Language (UBL)? is one of [u'1', u'2'] then Hide 32b1. What are the benefits of using this languag...
   • If 32b. Universal Business Language (UBL)? is one of [u'1', u'2'] then Hide 32b2. Are there any challenges or impediments imp...
   • If not 32c. Electronic Data Interchange (EDI)? = Yes then Hide 32c1. What are the benefits of using this languag...
   • If not 32c. Electronic Data Interchange (EDI)? = Yes then Hide 32c2. Are there any challenges or impediments imp...
   • If 32c. Electronic Data Interchange (EDI)? is one of [u'1', u'2'] then Hide 32c1. What are the benefits of using this languag...
   • If 32c. Electronic Data Interchange (EDI)? is one of [u'1', u'2'] then Hide 32c2. Are there any challenges or impediments imp...
   • If not 32d. United Nations/Electronic Data Interchange f... = Yes then Hide 32d1. What are the benefits of using this languag...
   • If not 32d. United Nations/Electronic Data Interchange f... = Yes then Hide 32d2. Are there any challenges or impediments imp...
   • If 32d. United Nations/Electronic Data Interchange f... is one of [u'1', u'2'] then Hide 32d1. What are the benefits of using this
languag...
   • If 32d. United Nations/Electronic Data Interchange f... is one of [u'1', u'2'] then Hide 32d2. Are there any challenges or
impediments imp...
   • If not 32e. Other? = Yes, please specify language: then Hide 32e1. What are the benefits of using this languag...
   • If not 32e. Other? = Yes, please specify language: then Hide 32e2. Are there any challenges or impediments imp...
   • If 32e. Other? is one of [u'1', u'2'] then Hide 32e1. What are the benefits of using this languag...
   • If 32e. Other? is one of [u'1', u'2'] then Hide 32e2. Are there any challenges or impediments imp...
   • If not 33. What format(s) can be used to view and share t... = Yes then Hide 33a1. What are the benefits of using this format?
   • If not 33. What format(s) can be used to view and share t... = Yes then Hide 33a2. Are there any challenges or impediments
imp...
   • If 33. What format(s) can be used to view and share t... is one of [u'1', u'2'] then Hide 33a1. What are the benefits of using this
format?
   • If 33. What format(s) can be used to view and share t... is one of [u'1', u'2'] then Hide 33a2. Are there any challenges or
impediments imp...
   • If not 33b. Tagged image file format (tiff)? = Yes then Hide 33b1. What are the benefits of using this format?
   • If not 33b. Tagged image file format (tiff)? = Yes then Hide 33b2. Are there any challenges or impediments imp...
   • If 33b. Tagged image file format (tiff)? is one of [u'1', u'2'] then Hide 33b1. What are the benefits of using this format?
   • If 33b. Tagged image file format (tiff)? is one of [u'1', u'2'] then Hide 33b2. Are there any challenges or impediments imp...
   • If not 33c. Joint photographic experts group (jpeg)? = Yes then Hide 33c1. What are the benefits of using this format?
   • If not 33c. Joint photographic experts group (jpeg)? = Yes then Hide 33c2. Are there any challenges or impediments imp...
   • If 33c. Joint photographic experts group (jpeg)? is one of [u'1', u'2'] then Hide 33c1. What are the benefits of using this format?
   • If 33c. Joint photographic experts group (jpeg)? is one of [u'1', u'2'] then Hide 33c2. Are there any challenges or impediments
imp...
   • If not 33d. Other? = Yes, please specify format: then Hide 33d1. What are the benefits of using this format?
   • If not 33d. Other? = Yes, please specify format: then Hide 33d2. Are there any challenges or impediments imp...
   • If 33d. Other? is one of [u'1', u'2'] then Hide 33d1. What are the benefits of using this format?
   • If 33d. Other? is one of [u'1', u'2'] then Hide 33d2. Are there any challenges or impediments imp...
 29. Does the e-system use or contain any proprietary data or have any special licensing requirements governing its use?
 Yes
 No
 Unknown
 30. Is the e-system custom-made or commercial-off-the-shelf (COTS)?
 Custom
 COTS

 Unknown
 31. What electronic and wireless technology(ies) are used by your e-system? Please select all that apply:
 Personal digital assistants (PDAs)
 Vehicle laptops
 Workplace computers
 Computer aid dispatch (CAD) terminals
 Home computers
 Landline telephones
 Cellular telephones
 Smartphones
 Videos
 Facsimile (FAX) machines
 Live web cameras
 Pagers
 Two-way radios
 Walkie-talkies
 Tablets
 Other, please identify: __________________________
 32. What type(s) of electronic data exchange language is used by your agency's/company's/organization's e-system? Please
select all that apply:
32a. Extensible Markup Language (XML)?
 Yes
 No
 Unknown
 32a1. What are the benefits of using this language?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
 32a2. Are there any challenges or impediments imposed by using this language?
 Yes, please describe: __________________________
 No
 Unknown
 32b. Universal Business Language (UBL)?
 Yes
 No
 Unknown
 32b1. What are the benefits of using this language?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
 32b2. Are there any challenges or impediments imposed by using this language?
 Yes, please describe: __________________________
 No
 Unknown
 32c. Electronic Data Interchange (EDI)?
 Yes
 No

 Unknown
 32c1. What are the benefits of using this language?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
 32c2. Are there any challenges or impediments imposed by using this language?
 Yes, please describe: __________________________
 No
 Unknown
 32d. United Nations/Electronic Data Interchange for Administration, Commerce, and Transport (UN/EDIFACT)?
 Yes
 No
 Unknown
 32d1. What are the benefits of using this language?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
 32d2. Are there any challenges or impediments imposed by using this language?
 Yes, please describe: __________________________
 No
 Unknown
 32e. Other?
 Yes, please specify language: __________________________
 No
 Unknown
 32e1. What are the benefits of using this language?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
 32e2. Are there any challenges or impediments imposed by using this language?
 Yes, please describe: __________________________
 No
 Unknown
 33. What format(s) can be used to view and share the data? Please select all that apply:
33a. Portable document format (pdf)?
 Yes
 No
 Unknown
 33a1. What are the benefits of using this format?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
 33a2. Are there any challenges or impediments imposed by using this format?

 Yes, please describe: __________________________
 No
 Unknown
 33b. Tagged image file format (tiff)?
 Yes
 No
 Unknown
 33b1. What are the benefits of using this format?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
 33b2. Are there any challenges or impediments imposed by using this format?
 Yes, please describe: __________________________
 No
 Unknown
 33c. Joint photographic experts group (jpeg)?
 Yes
 No
 Unknown
 33c1. What are the benefits of using this format?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
 33c2. Are there any challenges or impediments imposed by using this format?
 Yes, please describe: __________________________
 No
 Unknown
 33d. Other?
 Yes, please specify format: __________________________
 No
 Unknown
 33d1. What are the benefits of using this format?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
 33d2. Are there any challenges or impediments imposed by using this format?
 Yes, please describe: __________________________
 No
 Unknown
 34. Is your e-system scalable (i.e., able to expand if the amount of information increases)?
 Yes
 No
 Unknown

 35. If your e-system fails during an HM inspection or emergency, is a backup system/procedures available to ensure continuity
of information?
 Yes, please describe system/procedures: __________________________
 No
 Unknown
 36. Who enters HM information into your e-system? Please select all that apply:
 All agency/company/organization personnel
 Only agency/company/organization personnel with appropriate clearances
 Contractor personnel with appropriate clearances
 Shippers
 Carriers
 Other, please identify: __________________________
 Unknown
 37. How long is the HM information stored in your e-system after its initial generation?
 8 hours or less
 8+ hours to one week
 One week to one month
 One to six months
 Six months to one year
 Other, please identify storage time: __________________________
 Unknown
 38. When can the HM information in your e-system be accessed?
 24 hours a day, seven days a week
 During business hours, please specify business hours (use HH:MM AM/PM format) and days of week:
__________________________
 Other, please identify: __________________________
 Unknown
 39. Who can access the HM information in your e-system? Please select all that apply:
 All agency/company/organization personnel
 Only agency/company/organization personnel with appropriate clearances
 Contractor personnel with appropriate clearances
 Shippers
 Carriers
 External inspection personnel
 Emergency responders
 Other, please identify: __________________________
 Unknown

Page #10
Branching Information
   • If 40. Which technology readiness level best describ... = Level 5--technology product fully operational in real-world environment
then Hide 40b1. What is the anticipated time needed for the...
   • If 40. Which technology readiness level best describ... = Level 5--technology product fully operational in real-world environment
then Hide 40b2. How much money and labor (in U.S. dollars) ...
   • If 40. Which technology readiness level best describ... = Level 5--technology product fully operational in real-world environment
then Hide 40b3. What work is needed to bring the technology...
   • If 40. Which technology readiness level best describ... = Level 5--technology product fully operational in real-world environment
then Hide 40b4. How much more money and labor (in U.S. doll...
   • If not 40. Which technology readiness level best describ... = Level 5--technology product fully operational in real-world
environment then Hide 40a1. How long did it take for your e-system to g...
   • If not 40. Which technology readiness level best describ... = Level 5--technology product fully operational in real-world
environment then Hide 40a2. Can your agency/company/organization provid...
   • If not 40. Which technology readiness level best describ... = Level 5--technology product fully operational in real-world
environment then Hide 40a3. Estimated costs (in U.S. dollars):
   • If 40. Which technology readiness level best describ... is one of [u'1', u'2', u'3', u'4'] then Hide 40a1. How long did it take for your
e-system to g...
   • If 40. Which technology readiness level best describ... is one of [u'1', u'2', u'3', u'4'] then Hide 40a2. Can your
agency/company/organization provid...
   • If 40. Which technology readiness level best describ... is one of [u'1', u'2', u'3', u'4'] then Hide 40a3. Estimated costs (in U.S.
dollars):
   • If not 40. Which technology readiness level best describ... is one of [u'1', u'2', u'3', u'4'] then Hide 40b1. What is the anticipated
time needed for the...
   • If not 40. Which technology readiness level best describ... is one of [u'1', u'2', u'3', u'4'] then Hide 40b2. How much money and
labor (in U.S. dollars) ...
   • If not 40. Which technology readiness level best describ... is one of [u'1', u'2', u'3', u'4'] then Hide 40b3. What work is needed to
bring the technology...
   • If not 40. Which technology readiness level best describ... is one of [u'1', u'2', u'3', u'4'] then Hide 40b4. How much more money
and labor (in U.S. doll...
   • If 40. Which technology readiness level best describ... = Unknown then Hide 40a1. How long did it take for your e-system to g...
   • If 40. Which technology readiness level best describ... = Unknown then Hide 40a2. Can your agency/company/organization
provid...
   • If 40. Which technology readiness level best describ... = Unknown then Hide 40a3. Estimated costs (in U.S. dollars):
   • If 40. Which technology readiness level best describ... = Unknown then Hide 40b1. What is the anticipated time needed for the...
   • If 40. Which technology readiness level best describ... = Unknown then Hide 40b2. How much money and labor (in U.S. dollars)
...
   • If 40. Which technology readiness level best describ... = Unknown then Hide 40b3. What work is needed to bring the
technology...
   • If 40. Which technology readiness level best describ... = Unknown then Hide 40b4. How much more money and labor (in U.S.
doll...
   • If not 40a2. Can your agency/company/organization provid... = Yes then Hide 40a3. Estimated costs (in U.S. dollars):
   • If 40a2. Can your agency/company/organization provid... is one of [u'1', u'2', u'3'] then Hide 40a3. Estimated costs (in U.S.
dollars):
 40. Which technology readiness level best describes the technology used to operate your agency's/company's/organization's
e-system?
 Level 5--technology product fully operational in real-world environment
 Level 4--technology product operational in limited real-world environment
 Level 3--prototype demonstrated in laboratory environment
 Level 2--equipment and process concept formulated
 Level 1--basic technology principles observed
 Unknown
 40a1. How long did it take for your e-system to get to Level 5 from original conception?
 Zero to three months

 Three to six months
 Six months to one year
 One to two years
 More than two years
 Unknown
 40a2. Can your agency/company/organization provide an estimate of the costs to develop, implement, operate, and maintain its
e-system?
 Yes
 No
 Unknown
 My agency/company/organization does not want to provide this information at this time
 40a3. Estimated costs (in U.S. dollars):
 Development (one-time cost): __________________________
 Implementation (one-time cost): __________________________
 Operation (annual cost): __________________________
 Maintenance (annual cost): __________________________
 Total costs for development, implementation, operation, and maintenance (fill in this field if breakout costs are unknown):
__________________________
 40b1. What is the anticipated time needed for the technology to reach Level 5 (i.e., fully operational in real-world environment)?
 Zero to three months
 Three to six months
 Six months to one year
 One to two years
 More than two years
 Unknown
 40b2. How much money and labor (in U.S. dollars) has your agency/company/organization invested to date?
 Less than $5,000
 $5,000 to $10,000
 $10,000 to $25,000
 $25,000 to $50,000
 $50,000 to $100,000
 $100,000 to $250,000
 $250,000 to $500,000
 Greater than $500,000, please estimate amount: __________________________
 Unknown
 My agency/company/orgnization does not want to provide this information at this time
 40b3. What work is needed to bring the technology to Level 5?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
 40b4. How much more money and labor (in U.S. dollars) is needed to bring the technology to Level 5?
 Less than $5,000
 $5,000 to $10,000
 $10,000 to $25,000
 $25,000 to $50,000
 $50,000 to $100,000
 $100,000 to $250,000
 $250,000 to $500,000
 Greater than $500,000, please estimate amount: __________________________
 Unknown

 My agency/company/organization does not want to provide this information at this time

Page #11
Branching Information
   • If not 41. Did your agency's/company's/organization's em... = Yes then Hide 41a. How many employees received initial training...
   • If not 41. Did your agency's/company's/organization's em... = Yes then Hide 41b. In general, what are the job titles/business...
   • If not 41. Did your agency's/company's/organization's em... = Yes then Hide 41c. How long does the initial training take to c...
   • If not 41. Did your agency's/company's/organization's em... = Yes then Hide 42. Is refresher training on the e-system provide...
   • If not 41. Did your agency's/company's/organization's em... = Yes then Hide 43. Can your agency/company/organization provide
...
   • If 41. Did your agency's/company's/organization's em... is one of [u'1', u'2'] then Hide 41a. How many employees received initial
training...
   • If 41. Did your agency's/company's/organization's em... is one of [u'1', u'2'] then Hide 41b. In general, what are the job
titles/business...
   • If 41. Did your agency's/company's/organization's em... is one of [u'1', u'2'] then Hide 41c. How long does the initial training take
to c...
   • If 41. Did your agency's/company's/organization's em... is one of [u'1', u'2'] then Hide 42. Is refresher training on the e-system
provide...
   • If 41. Did your agency's/company's/organization's em... is one of [u'1', u'2'] then Hide 42a. How often is refresher training
provided?
   • If 41. Did your agency's/company's/organization's em... is one of [u'1', u'2'] then Hide 42b. How long does the refresher training
take to...
   • If 41. Did your agency's/company's/organization's em... is one of [u'1', u'2'] then Hide 42c. Are all/most employees who receive
initial e...
   • If 41. Did your agency's/company's/organization's em... is one of [u'1', u'2'] then Hide 43. Can your agency/company/organization
provide ...
   • If 41. Did your agency's/company's/organization's em... is one of [u'1', u'2'] then Hide 43a. Use any combination of the following
categor...
   • If not 42. Is refresher training on the e-system provide... = Yes then Hide 42a. How often is refresher training provided?
   • If not 42. Is refresher training on the e-system provide... = Yes then Hide 42b. How long does the refresher training take to...
   • If not 42. Is refresher training on the e-system provide... = Yes then Hide 42c. Are all/most employees who receive initial e...
   • If 42. Is refresher training on the e-system provide... is one of [u'1', u'2'] then Hide 42a. How often is refresher training provided?
   • If 42. Is refresher training on the e-system provide... is one of [u'1', u'2'] then Hide 42b. How long does the refresher training take
to...
   • If 42. Is refresher training on the e-system provide... is one of [u'1', u'2'] then Hide 42c. Are all/most employees who receive initial
e...
   • If not 43. Can your agency/company/organization provide ... = Yes then Hide 43a. Use any combination of the following categor...
   • If 43. Can your agency/company/organization provide ... is one of [u'1', u'2'] then Hide 43a. Use any combination of the following
categor...
 41. Did your agency's/company's/organization's employees receive initial training on the e-system?
 Yes
 No
 Unknown
 41a. How many employees received initial training?
 1 to 10
 11 to 25
 26 to 50
 51 to 100
 101 to 200
 201 to 300
 More than 300, please provide number: __________________________
 Unknown
 41b. In general, what are the job titles/business classifications of these employees? Enter "UNKNOWN" if you do not know the
titles/classifications.

_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
 41c. How long does the initial training take to complete?
 Less than 2 hours
 2 to 4 hours
 4 to 8 hours
 More than 8 hours
 Unknown
 42. Is refresher training on the e-system provided?
 Yes
 No
 Unknown
 42a. How often is refresher training provided?
 Quarterly (four times per year)
 Semi-annually (two times per year)
 Annually (once each year)
 Other, please identify frequency: __________________________
 Unknown
 42b. How long does the refresher training take to complete?
 Less than 2 hours
 2 to 4 hours
 4 to 8 hours
 More than 8 hours
 Unknown
 42c. Are all/most employees who receive initial e-system training provided with refresher training?
 Yes
 No
 Unknown
 43. Can your agency/company/organization provide an estimate of the costs for training employees on its e-system?
 Yes
 No
 Unknown
 My agency/company/organization does not want to provide this information at this time
 43a. Use any combination of the following categories to quantify the training costs (in U.S. dollars):
 Initial training costs per person: __________________________
 Initial training costs agency-/company-/organization-wide: __________________________
 Refresher training costs per person: __________________________
 Refresher training costs agency-/company-/organization-wide: __________________________

Page #12
Branching Information
   • If not 44. Did your agency/company/organization incorpor... = Yes then Hide 44a. Can your agency/company/organization
provide...
   • If 44. Did your agency/company/organization incorpor... is one of [u'1', u'2'] then Hide 44a. Can your
agency/company/organization provide...
 44. Did your agency/company/organization incorporate a customer outreach/education program as part of its e-system
implementation?
 Yes
 No
 Unknown
 44a. Can your agency/company/organization provide an estimate of the costs (in U.S. dollars) to conduct customer
outreach/education on its e-system?
 Yes, please provide estimate (in U.S. dollars): __________________________
 No
 Unknown
 My agency/company/organization does not want to provide this information at this time

Page #13
Branching Information
   • If not 46. Which of the following entities outside your a... contains one of [u'0', u'1', u'2', u'3', u'4', u'5', u'6', u'7'] then Hide 46a.
What type of involvement and input did these...
   • If 46. Which of the following entities outside your a... contains one of [u'8', u'9'] then Hide 46a. What type of involvement and input
did these...
 45. What type(s) of security is in place to prevent unauthorized access to your agency's/company's/organization's e-system?
Please select all that apply:
 Login account
 Password
 Biometric
 Keycard
 Other, please identify: __________________________
 Unknown
 46. Which of the following entities outside your agency/company/organization directly utilize your e-system? Please select all
that apply:
 Shippers
 Carriers
 Emergency responders
 Inspection personnel
 Federal government officials
 State governmental officials
 Local government officials
 Other, please identify: __________________________
 Unknown
 No external entities directly utilize the e-system
 46a. What type of involvement and input did these entities have in the design and development of your
agency's/company's/organization's e-system?
 No involvement/input
 Minimal involvement/input; they were involved in the final review
 Some involvement/input; they provided input to the draft design
 Significant involvement/input; they were involved in developing the initial design
 Unknown

Page #14
Branching Information
   • If 47c. What benefits resulted from your agency's/co... = [u'7'] then Hide 47c1. What constraints did your agency/company/or...
   • If not 47d. Has your agency/company/organization perform... = Yes then Hide 47d1. Can you share the results of these studies ...
   • If 47d. Has your agency/company/organization perform... is one of [u'1', u'2'] then Hide 47d1. Can you share the results of these
studies ...
   • If not 47c. What benefits resulted from your agency's/co... contains one of [u'0', u'1', u'2', u'3', u'4', u'5', u'6'] then Hide 47c1. What
constraints did your agency/company/or...
   • If not 47g. Has your agency/company/organization identif... = Yes then Hide 47g1. Please select all identified impediments/li...
   • If not 47g. Has your agency/company/organization identif... = Yes then Hide 47g2. Please provide additional details regarding...
   • If 47g. Has your agency/company/organization identif... is one of [u'1', u'2'] then Hide 47g1. Please select all identified
impediments/li...
   • If 47g. Has your agency/company/organization identif... is one of [u'1', u'2'] then Hide 47g2. Please provide additional details
regarding...
 47. For agencies/companies/organizations with an e-system:
47a.  What constraints did your e-system have to overcome to be successfully used by your agency/company/organization? Please
select all that apply:
 Provide immediate access to HM information in all geographic areas
 Work with other internal (to the agency/company/organization) electronic systems
 Work with external (outside the agency/company/organization) electronic systems
 Provide a financial benefit
 Integrate with current paper system
 Ease of data entry procedures
 Provide equivalent or better level of security
 Accepted by personnel
 Usability of commercial off the shelf (COTS) system components
 Usability of custom system components
 Other, please describe: __________________________
 No constraints
 Unknown
 47b. What benefits does the e-system offer over a paper-based system? Please select all that apply:
 Reduced staff time and/or cost to prepare shipping papers
 Reduced costs for transfer between modes or carriers
 Reduced error rate in data entry
 Ease of data entry
 Reduced costs for hardcopy storage and retrieval
 Faster transport times for shipments
 Improved customer satisfaction
 Reduced insurance or risk management costs
 Improved HM inspection data
 Decreased time needed for HM inspections
 Faster delivery of HM information to emergency responders
 More accurate HM data for emergency preparedness and response
 Increased operational efficiency
 Improved regulatory compliance
 More efficient HM tracking and locating
 Improved HM data security
 Other, please describe: __________________________
 No benefits
 Unknown
 47c. What benefits resulted from your agency's/company's/organization's customer outreach/education efforts regarding your
e-system? Please select all that apply:

 Improved customer satisfaction
 Increased business opportunities
 Reduced insurance or risk management costs
 Increased operational efficiency
 Other, please describe: __________________________
 No benefits
 Unknown
 Not applicable, my agency/company/organization does not have a customer outreach/education program
 47c1. What constraints did your agency/company/organization need to overcome during customer outreach/education regarding
your e-system? Please select all that apply:
 Work with external (outside the agency/company/organization) electronic systems
 Provide a financial benefit
 Integrate with current paper system
 Ease of data entry procedures
 Provide equivalent or better level of security
 Accepted by personnel
 Other, please describe: __________________________
 Unknown
 47d. Has your agency/company/organization performed any studies/analyses on the effectiveness of your e-system, including
the e-system's impacts on your agency/company/organization?
 Yes
 No
 Unknown
 47d1. Can you share the results of these studies with us?
 Yes, please describe results: __________________________
 No
 47e. In your opinion, what can improve your e-system's capability? Enter "NO INFORMATION" if you do not have any ideas for
how to improve your e-system's capability.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
 47f. With respect to real-world application, has your agency/company/organization observed any positive or negative
interactions between its e-system technology and other e-system technologies?
 Yes, please describe these interactions: __________________________
 No
 Unknown
 47g. Has your agency/company/organization identified any e-system impediments/limitations?
 Yes
 No
 Unknown
 47g1. Please select all identified impediments/limitations:
 Lack of access in rural areas
 Incompatibility issues with other internal or external e-systems
 Problems with electronic/wireless devices
 Problems with the data language (e.g., XML, EDI, etc.)
 Problems with the communication mechanism (e.g., email, Internet reference/link, etc.)
 Problems with the data format (e.g., jpeg, tiff, etc.)
 Other, please describe: __________________________

 47g2. Please provide additional details regarding the impediment(s)/limitation(s), and explain how your
agency/company/organization addressed the impediment(s)/limitation(s). Enter "NO INFORMATION" if you do not have any
additional details.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________

Page #15
 48. For agencies/companies/organizations without an e-system:
48a.  What constraints would an e-system have to overcome to be successfully used by your agency/company/organization? Please
select all that apply:
 Provide immediate access to HM information in all geographic areas
 Work with other internal (to the agency/company/organization) electronic systems
 Work with external (outside the agency/company/organization) electronic systems
 Provide a financial benefit
 Integrate with current paper system
 Ease data entry procedures
 Provide equivalent or better level of security
 Be accepted by personnel
 Use commercial off the shelf (COTS) system components
 Use custom system components
 Other, please describe: __________________________
 No constraints
 Unknown
 Not applicable
 48b. What benefits would an e-system offer over a paper-based system? Please select all that apply:
 Reduced staff time and/or cost to prepare shipping papers
 Reduced costs for transfer between modes or carriers
 Reduced error rate in data entry
 Ease of data entry
 Reduced costs for hardcopy storage and retrieval
 Faster transport times for shipments
 Improved customer satisfaction
 Reduced insurance or risk management costs
 Improved HM inspection data
 Decreased time needed for HM inspections
 Faster delivery of HM information to emergency responders
 More accurate HM data for emergency preparedness and response
 Increased operational efficiency
 Improved regulatory compliance
 More efficient HM tracking and locating
 Improved HM data security
 Other, please describe: __________________________
 No benefits
 Unknown
 Not applicable

Page #16
Branching Information
   • If not 49. Do you have any lessons learned that should b... = Yes then Hide 49a. Please describe the lesson(s) learned:
   • If 49. Do you have any lessons learned that should b... = No then Hide 49a. Please describe the lesson(s) learned:
 49. Do you have any lessons learned that should be considered for improvement of e-commerce?
 Yes
 No
 49a. Please describe the lesson(s) learned:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________