{"data":{"id":"us/23-cfr-appendix-a-to-part-1340","jurisdiction":"us","citation":"23 CFR Appendix A to Part 1340","heading":"Appendix A to Part 1340—State Seat Belt Use Survey Reporting Form","body":"PART A: To be completed by the Governor's Highway Safety Representative (GR) or if applicable, the Coordinator of the State Highway Safety Office.\nState:\nCalendar Year of Survey:\nStatewide Seat Belt Use Rate:\nI hereby certify that:\n• ________________has been designated by the Governor as the State's Highway Safety Representative (GR), and if applicable, the GR has delegated the authority to sign the certification in writing to __________________, the Coordinator of the State Highway Safety Office.\n• The reported Statewide seat belt use rate is based on a survey design that was approved by NHTSA, in writing, as conforming to the Uniform Criteria for State Observational Surveys of Seat Belt Use, 23 CFR Part 1340.\n• The survey design has remained unchanged since the survey was approved by NHTSA.\n• ________________, a qualified survey statistician, has reviewed the seat belt use rate reported above and information reported in Part B and has determined that they meet the Uniform Criteria for State Observational Surveys of Seat Belt Use, 23 CFR Part 1340.\nSignature\nDate\nPrinted name of signing official\nPart B—Data Collected at Observation Sites\nSite ID Site type 1 Date observed Sample weight Number of drivers Number of front Passengers Number of occupants 2 belted Number of occupants unbelted Number of occupants with unknown belt use\nTotal\nStandard Error of Statewide Belt Use Rate 3 ______\nNonresponse Rate, as provided in § 1340.9(f)\nNonresponse rate for the survey variable seat belt use: ________","path":["Title 23—Highways","CHAPTER III—NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION","PART 1340—UNIFORM CRITERIA FOR STATE OBSERVATIONAL SURVEYS OF SEAT BELT USE"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-23.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:24:50Z","sha256":"47f5bbabb1870bd4f9cfdc88627530645e0e0771eb3a26f43ca56b79dbb9d02c","source_id":"us-cfr","stale":true,"prev":"us/23-cfr-1340.13","next":"us/24-cfr-0.1"},"notice":"GroundRules: Original legal text. Not legal advice."}