Screen shots of Drugged Driving Survey (DDS)

Assessing an Online Process to Study the Prevalence of Drugged Driving in the U.S.: Development of the Drugged Driving Reporting System

Documents and Forms

Document Name Document Type
Form 1 Screen shots of Drugged Driving Survey (DDS) Form and Instruction
1 Screen Shot Survey $0 Incentive Drugged Driving - Attachment B - Screen Shot Survey $0 Incentive.pdf Form and Instruction
2 Screen Shot Survey $10 Incentive Drugged Driving - Attachment C - Screen Shot Survey $10 Incentive.pdf Form and Instruction
3 Screen Shot Survey $20 Incentive Drugged Driving - Attachment D - Screen Shot Survey - $20 Incentive.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Screen shots of Drugged Driving Survey (DDS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Screen Shot Survey $0 Incentive	Drugged Driving - Attachment B - Screen Shot Survey $0 Incentive.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	2	Screen Shot Survey $10 Incentive	Drugged Driving - Attachment C - Screen Shot Survey $10 Incentive.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	3	Screen Shot Survey $20 Incentive	Drugged Driving - Attachment D - Screen Shot Survey - $20 Incentive.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,750	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,750	3,750
Annual IC Time Burden (Hours)	750	750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.