View Information Collection (IC)

View Information Collection (IC)

IC Title:	Accident/Incident Reporting and Recordkeeping	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 49 CFR 225

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FRA F 6180.39i	Railroad Accident/Incident Notification and Initial Investigation Report	FRA F 6180.39i.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp	Yes	Yes	Fillable Printable
Form	FRA F 6180.54	Rail Equipment Accident/Incident Report	FRA F 6180.54.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp	Yes	No	Paper Only
Form	FRA F 6180.55	Railroad Injury and Illness Summary	FRA F 6180.55.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp	Yes	No	Paper Only
Form	FRA F 6180.55a	Railroad Injury and Illness Summary (Continuation Sheet)	FRA F 6180.55a.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp	Yes	No	Paper Only
Form	FRA F 6180.56	Annual Report of Employee Hours and Casualties, By State	FRA F 6180.56.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp	Yes	No	Paper Only
Form and Instruction	FRA F 6180.57	Highway-Rail Grade Crossing Accident/Incident Report	FRA F 6180.57.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp	Yes	No	Paper Only
Form and Instruction	FRA F 6180.78	Notice to Railroad Employee Involved in Rail Equipment Accident/Incident Attributed to Employee Human Factor (Employee Statement Supplementing Railroad Accident Report)	FRA F 6180.78.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms.Default.asp	Yes	No	Paper Only
Form	FRA F 6180.97	Employee Human Factor Attachment	FRA F 6180.97.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp	Yes	No	Paper Only
Form	FRA F 6180.98	Railroad Employee Injury and/or Illness Record	FRA F 6180.98.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp	Yes	No	Paper Only
Form	F RA F 6180.107	Alternative Record For Illness Claimed To Be Work-Related	FRA F 6180.107.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms.Default.asp	Yes	No	Paper Only
Form	FRA F 6180.99	FRA Batch Control For Magnetic Media	FRA F 6180.99.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms.Default.asp	Yes	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 685	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 40 %

	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	78,002	0	0	0	0	78,002
Annual IC Time Burden (Hours)	47,521	0	0	0	0	47,521
Annual IC Cost Burden (Dollars)	178,286	0	0	0	0	178,286

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.