Form FRA F 6180.113 FRA F 6180.113 Reflectorization Implementation Compliance Report

OMB No. 2130-xxxx

REFLECTORIZATION IMPLEMENTATION COMPLIANCE REPORT
Instructions for completing form:
If submitting this form to FRA as an initial Reflectorization Implementation Compliance Report in
accordance with 49 CFR 224.107(a)(2)(ii) and/or (b)(2)(ii), complete Parts I, II, III and IV. If
submitting this form in accordance with 49 CFR 224.107(a)(3) and/or (b)(3), complete Parts I, II, III,
IV, and V.
If this form is being submitted to FRA as an updated Reflectorization Implementation Compliance
Report required by 49 CFR 224.107(a)(2)(ii)(B) or (b)(2)(ii)(B), complete Parts I, II, III, and V. In
Part V, report the car/locomotive number(s) identifying each freight car and locomotive equipped
with retroreflective sheeting conforming to 49 CFR Part 224 during this reporting period
Part I: Identification
Railroad or Car Owner:
Railroad or Car Owner Reporting Code:
Preparer Information:
Name:

Title:

Address:

Phone:
Fax:
Email:

Part II: Type of Submission
Initial Submission
Updated Compliance Report
Part III: Identification of freight rolling stock fleet subject to 49 CFR Part 224
A. How many freight cars in your fleet are subject to 49 CFR part 224?
B. How many locomotives in your fleet are subject to 49 CFR part 224?
Part IV: Certification (Complete only if Part II: Type of Submission is Initial Submission)
By filing this Reflectorization Implementation Compliance Report and any accompanying documents
or electronic files with FRA, the undersigned Freight Rolling Stock Owner is electing to follow the
alternative schedules for equipping its freight rolling stock with reflective material as set forth in 49
CFR §§224.107(a)(2)(ii) and/or (b)(2)(ii). By completing, executing, and filing this Compliance
Report with FRA, the undersigned Freight Rolling Stock Owner is certifying that its entire fleet of
freight rolling stock subject to 49 CFR Part 224 (Part 224) will be equipped with retroreflective
sheeting conforming to the requirements of Part 224 in accordance with the schedules set forth in
49 CFR §224.107(a)(2)(ii) and/or (b)(2)(ii). Failure to meet the minimum requirements of Part 224
may result in the assessment of civil penalties or other enforcement action by FRA.
Signature of Corporate Officer/Car owner:

Name:
Title:
Form FRA F6180.113 11/03

Date:

OMB No. 2130-xxxx

Part V: Identification of rail freight rolling stock conforming to 49 CFR Part 224
Type (check one):
Reapplieda

Freight
Car
Locomotive

Type (check one):
Identification
Number:

Reapplieda

Freight
Car
Locomotive

Identification
Number:

a. Check if freight car/locomotive was reported in Part V of a previous Reflectorization Implementation Compliance Report as conforming to 49
CFR Part 224, but 100% of the retroreflective sheeting on the car/locomotive was replaced with sheeting conforming to Part 224 in this reporting
period.
Public reporting burden for this information collection is estimated to average eight hours per response. This estimate included time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this collection of information is 2130-XXXX.

Form FRA F6180.113 11/03