Accident/Incident Reporting and Recordkeeping

OMB: 2130-0500

IC ID: 26389

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2130-0500 can be found here:

Documents and Forms

Document Name Document Type
Form FRA F 6180.56 Accident/Incident Reporting and Recordkeeping Form
FRA F 6180.39i Railroad Accident/Incident Notification and Initial Inve FRA F 6180.39i.pdf safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp Form
FRA F 6180.54 Rail Equipment Accident/Incident Report FRA F 6180.54.pdf safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp Form
FRA F 6180.55 Railroad Injury and Illness Summary FRA F 6180.55.pdf safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp Form
FRA F 6180.55a Railroad Injury and Illness Summary (Continuation Sheet) FRA F 6180.55a.pdf safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp Form
FRA F 6180.56 Annual Report of Employee Hours and Casualties, By State FRA F 6180.56.pdf safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp Form
FRA F 6180.57 Highway-Rail Grade Crossing Accident/Incident Report FRA F 6180.57.pdf safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp Form and Instruction
FRA F 6180.78 Notice to Railroad Employee Involved in Rail Equipment A FRA F 6180.78.pdf safetydata.fra.dot.gov/officeofsafety/Forms.Default.asp Form and Instruction
FRA F 6180.97 Employee Human Factor Attachment FRA F 6180.97.pdf safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp Form
FRA F 6180.98 Railroad Employee Injury and/or Illness Record FRA F 6180.98.pdf safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp Form
F RA F 6180.107 Alternative Record For Illness Claimed To Be Work-Relate FRA F 6180.107.pdf safetydata.fra.dot.gov/officeofsafety/Forms.Default.asp Form
FRA F 6180.99 FRA Batch Control For Magnetic Media FRA F 6180.99.pdf safetydata.fra.dot.gov/officeofsafety/Forms.Default.asp Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Accident/Incident Reporting and Recordkeeping	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 49 CFR 225

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FRA F 6180.56	Annual Report of Employee Hours and Casualties, By State	FRA F 6180.56.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp	Yes	No	Paper Only
Form and Instruction	FRA F 6180.57	Highway-Rail Grade Crossing Accident/Incident Report	FRA F 6180.57.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp	Yes	No	Paper Only
Form and Instruction	FRA F 6180.78	Notice to Railroad Employee Involved in Rail Equipment Accident/Incident Attributed to Employee Human Factor (Employee Statement Supplementing Railroad Accident Report)	FRA F 6180.78.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms.Default.asp	Yes	No	Paper Only
Form	FRA F 6180.97	Employee Human Factor Attachment	FRA F 6180.97.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp	Yes	No	Paper Only
Form	FRA F 6180.98	Railroad Employee Injury and/or Illness Record	FRA F 6180.98.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp	Yes	No	Paper Only
Form	F RA F 6180.107	Alternative Record For Illness Claimed To Be Work-Related	FRA F 6180.107.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms.Default.asp	Yes	No	Paper Only
Form	FRA F 6180.99	FRA Batch Control For Magnetic Media	FRA F 6180.99.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms.Default.asp	Yes	No	Paper Only
Form	FRA F 6180.39i	Railroad Accident/Incident Notification and Initial Investigation Report	FRA F 6180.39i.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp	Yes	Yes	Fillable Printable
Form	FRA F 6180.54	Rail Equipment Accident/Incident Report	FRA F 6180.54.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp	Yes	No	Paper Only
Form	FRA F 6180.55	Railroad Injury and Illness Summary	FRA F 6180.55.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp	Yes	No	Paper Only
Form	FRA F 6180.55a	Railroad Injury and Illness Summary (Continuation Sheet)	FRA F 6180.55a.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp	Yes	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 685	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 40 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	78,002	1,000	77,002
Annual IC Time Burden (Hours)	47,521	1,500	46,021
Annual IC Cost Burden (Dollars)	178,286	2,286	176,000

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.