Information Collection

Safety Improvement Report, Accident Prevention Counselor Activity Reports

IC 25563 under ICR 200112-2120-003 · OMB 2120-0057.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2120-0057 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Safety Improvement Report, Accident Prevention Counselor Activity Reports	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	8740-5				Yes	Yes
Form	8740-6				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,792	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 10 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	17,392	46	17,346
Annual IC Time Burden (Hours)	1,769	7	1,762
Annual IC Cost Burden (Dollars)	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.