Form 1 Carrier Survey Phase I

OMB Control No. 2126-TBD

Expiration Date: Month/Day/Year

VIRGINIA POLYTECHNIC INSTITUTE AND STATE UNIVERSITY

Carrier Maintenance Manager Recruitment, Online Survey

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Public 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 2126-XXXX.  Public reporting for this collection of information is estimated to be approximately 5 minutes per response, including the time for reviewing instructions and 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, Federal Motor Carrier Safety Administration, MC-RRA, 1200 New Jersey Avenue, SE, Washington, D.C. 20590.

Instructions:

This application will be used to identify contact information for you to complete a survey and to identify the type of experiences your carrier has had with regard to commercial vehicle maintenance. All answers provided in the survey will be de-identified. Personal and carrier information provided in this application will not be identified with your survey response.

Contact Information:

Name: ___________________________

Email: ___________________________

Phone Number: ___________________________

Carrier Name: ___________________________

Carrier DOT Number: ___________________________

Application:

1. What is your current role in the Carrier?

   • Technician (less than 10 years of experience)

   • Technician, Expert (10 or more years of experience)

   • Technician, Manager

   • Mid-Level Manager, Maintenance and Technical Lead

   • High-Level Manager, Maintenance/Technical/Operations Strategy

   • Owner-Operator

   • Carrier Owner, Not operator

   • Other (please list): ___________________________

2. How many years has your carrier been in operation? ___________________________

3. How many power unit vehicles does your carrier operate? (select one)

• 1

• 2 to 6

• 7 to 20

• 21 to 100

• 101 to 500

• 501 or more

4. What types of vehicles does your carrier operate? (check all that apply)

• Single-unit trucks

• Tractor-truck power unit vehicles only

• Tractor-trailer vehicles

• Single-unit motor-coach buses

• School buses

• Other passenger vehicles (e.g., vans, mini buses)

5. Has your carrier been involved in a State or FMCSA intervention activity in the last 24 months due in part to maintenance violations (e.g., warning letter, off-site investigation, on-site investigation)?

• Yes

• No

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