Information Collection

Medical Exemption Petition

IC 196925 under ICR 201103-2120-001 · OMB 2120-0034.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2120-0034 can be found here:

Documents and Forms

Document Name Document Type
Form 8500-20 Medical Exemption Petition Form
8500-20 Medical Exemption Petition 8500-20.pdf www.faa.gov/documentLibrary/media/form/faa8500-20.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medical Exemption Petition	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 14 CFR 61 14 CFR 67

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	8500-20	Medical Exemption Petition	8500-20.pdf	http://www.faa.gov/documentLibrary/media/form/faa8500-20.pdf	Yes	No	Fillable Printable

Line of Business: Transportation

Subfunction: Air Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 622	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	622	622
Annual IC Time Burden (Hours)	81	81
Annual IC Cost Burden (Dollars)	0	0

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.