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ADS one-day reports, initial
Incident Reporting for Automated Driving Systems (ADS) and Level 2 Advanced Driver Assistance Systems (ADAS)
OMB: 2127-0754
IC ID: 248100
OMB.report
DOT/NHTSA
OMB 2127-0754
ICR 202106-2127-003
IC 248100
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2127-0754 can be found here:
2022-12-19 - Revision of a currently approved collection
2021-12-30 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form NHTSA Form 1612
ADS one-day reports, initial
Form
NHTSA Form 1612 ADS ADAS Inicident Report
[STATIC IMAGE + WATERMARK] - NHTSA Form 1612 - ADS ADAS Incident Report Form.png
Form
NHTSA Form 1612 ADS ADAS Inicident Report
[STATIC IMAGE + WATERMARK] - NHTSA Form 1612 - ADS ADAS Incident Report Form.png
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
ADS one-day reports, initial
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Mandatory
CFR Citation:
49 CFR 510
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
NHTSA Form 1612
ADS ADAS Inicident Report
[STATIC IMAGE + WATERMARK] - NHTSA Form 1612 - ADS ADAS Incident Report Form.png
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Transportation
Subfunction:
Ground Transportation
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
10
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
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
10
0
10
0
0
0
Annual IC Time Burden (Hours)
20
0
20
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
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.