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Medical Examination
MEDICAL EXAMINATION
OMB: 2125-0080
IC ID: 141791
OMB.report
DOT/FHWA
OMB 2125-0080
ICR 198109-2125-001
IC 141791
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2125-0080 can be found here:
1997-07-23 - Reinstatement without change of a previously approved collection
1993-12-17 - Reinstatement with change of a previously approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
MEDICAL EXAMINATION
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
589,680
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
589,360
0
0
589,360
0
0
Annual IC Time Burden (Hours)
29,484
0
0
29,484
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.