MEDICAL EXAMINATION 2107

ICR 198212-2125-006

OMB: 2125-0080

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
141792
Migrated
ICR Details
2125-0080 198212-2125-006
Historical Active 198109-2125-001
DOT/FHWA
MEDICAL EXAMINATION 2107
Revision of a currently approved collection   No
Regular
Approved without change 03/24/1983
Retrieve Notice of Action (NOA) 12/27/1982
This item is approved for six months only, through September 30, 1983. Not later than June 30, 1983, this item must be resubmitted in a single clearance request with a single supporting statement, together with the following: Waiver--Initial and Renewal (OMB No. 2125-0091).
  Inventory as of this Action Requested Previously Approved
09/30/1983 09/30/1983 01/31/1983
589,360 0 589,360
29,484 0 29,484
0 0 0

MEDICAL EXAMINATION REQUIRED BY 49 CFR 391.43 TO DETERMINE IF DRIVER IS PHYSICALLY QUALIFIED. RETENTION OF MEDICAL CERTIFICATE (49 CFR 391. ISSUED BY DOCTOR PERMITS FHWA TO VERIFY QUALIFICATIONS OF DRIVER.

None
None


No

1
IC Title Form No. Form Name
MEDICAL EXAMINATION 2107

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 589,360 589,360 0 0 0 0
Annual Time Burden (Hours) 29,484 29,484 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/27/1982


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