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Report Of Personal Injury Or Loss Of Life
REPORT OF PERSONAL INJURY OR LOSS OF LIFE
OMB: 2115-0004
IC ID: 140358
OMB.report
DOT/USCG
OMB 2115-0004
ICR 198105-2115-003
IC 140358
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2115-0004 can be found here:
1982-07-12 - No material or nonsubstantive change to a currently 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:
REPORT OF PERSONAL INJURY OR LOSS OF LIFE
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
Form
CG-924E
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,850
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
2,850
0
250
0
0
2,600
Annual IC Time Burden (Hours)
941
0
83
0
0
858
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.