Form NHTSA Form 1811 NHTSA Form 1811 Eligibility Questionnaire

Start of Block: Screener

intro Thank you for your interest in our study on motorcycle technology. We are interested in motorcycle users' thoughts on different motorcycle safety technology. Findings from this short survey will be used to inform new motorcycle technology policy and procedures. First, we will ask a few questions to see if this study is right for you. If yes, the internet survey will walk you through the informed consent and rest of the questions. Your honesty and your time are appreciated. 

ride_freq How many times have you ridden a motorcycle in the past year?   When we talk about motorcycles or motorcycles, we mean a "motor vehicle with motive power having a seat or saddle for the use of the rider and designed to travel on not more than three wheels in contact with ground” (National Highway Traffic Safety Administration; 49 CFR 571.3).

• 0 times (1)

• 1-5 times (2)

• 6-10 times (3)

• 11-15 times (4)

• More than 15 times (5)

own_num How many motorcycles do you own?

• 0 (1)

• 1 (2)

• 2 (3)

• 3 (4)

• 4 or more (5)

live_in_us Do you live in the United States?

• No (1)

• Yes (2)

End of Block: Screener

*This is an electronically-administered survey instrument. The site that contains this information will also display the following:

NHTSA Form 1811

OMB Control No: 2127-XXXX

Expiration: XX-XX-2028

Paperwork Reduction Act 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. The information collected on this form will be used to better understand current consumer perceptions of the utility and availability of crash avoidance technologies for motorcycles, including consumer willingness to use and the impact of various contextual factors. The information will be used to inform agency policymaking and consumer education efforts. We estimate that it will take approximately 1 minute to complete the survey. The information collected is 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., Room W45-205, Washington, DC, 20590.