Medical Standards and Certification

Forms and Documents

Document Name	Status
Form 8500-7 Medical Standards and Certification Form	Removed
Form 8500-8 Application for Airman Medical Certificate or Airman Medical and Student Pilot Certificate Form and Instruction	New
Form 8500-20 Medical Exemption Petition Form	New
Form 8500-7 Report of Eye Evaluation, Ophthalmologic Evaluation for Glaucoma Form	New
2120-0034 2011.doc Supporting Statement A	2011-03-15

IC Document Collections

IC ID	Document Title	Status
25531	Medical Standards and Certification Form	Removed
196926	Application for Airman Medical Certificate or Airman Medical and Student Pilot Certificate Form and Instruction	New
196925	Medical Exemption Petition Form	New
196924	Report of Eye Evaluation, Ophthalmologic Evaluation for Glaucoma Form	New

ICR Details

OMB Control No: 2120-0034	ICR Reference No: 201103-2120-001
Status: Historical Active	Previous ICR Reference No: 200801-2120-006
Agency/Subagency: DOT/FAA	Agency Tracking No:
Title: Medical Standards and Certification
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/28/2011
	Date Received in OIRA: 04/08/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2014	36 Months From Approved	08/31/2011
Responses	412,226	0	440,000
Time Burden (Hours)	577,982	0	573,076
Cost Burden (Dollars)	33,440,000	0	33,440,000

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Abstract: The DOT/FAA certification program is implemented by Title 14 CFR parts 61 and 67. The Parts prescribes minimum airman medical standards, and duration of a medical certificate. Information collected substantiates the applicant's eligibility.

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Authorizing Statute(s): US Code: 49 USC 44701 Name of Law: General requirements
   US Code: 49 USC 44702 Name of Law: Issuance of certificates
   US Code: 49 USC 44703 Name of Law: Airman certificates
   US Code: 49 USC 44709 Name of Law: Amendments, modifications, suspensions, and revocations of certificates
   US Code: 49 USC 40113 Name of Law: Administrative
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 66422	10/28/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 5648	02/01/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Medical Exemption Petition	8500-20	Medical Exemption Petition
Medical Standards and Certification	8500-7, FAA-8500-14, FAA-8500-20, 8500-8	Report of Eye Evaluation ,   Opthamological Evauation for Glaucoma ,   Medical Exemption Petition ,   Application For Airman Medical Certificate or Airman Medical and Student Pilot Certificate
Report of Eye Evaluation, Ophthalmologic Evaluation for Glaucoma	8500-7	Report of Eye Evaluation
Application for Airman Medical Certificate or Airman Medical and Student Pilot Certificate	8500-8	Application for Airman Medical Certificate or Airman Medical and Student Pilot Certificate

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	412,226	440,000	0	-27,774	0	0
Annual Time Burden (Hours)	577,982	573,076	0	4,906	0	0
Annual Cost Burden (Dollars)	33,440,000	33,440,000	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The burden hours for Forms 8500-7, -14, and –20 increased for this submission because more pilots applied for medical certification during this reporting period; based on those figures, we adjusted our estimate. There have been no program changes.

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Annual Cost to Federal Government: $8,921,836

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/08/2011

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