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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.