Information Collection

Railroad Trespasser Death Study

IC 26504 under ICR 201201-2130-004 · OMB 2130-0563.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FRA-F-6180.117 Railroad Trespasser Death Study	Form
FRA-F-6180.117 Report of Railroad Trespasser Death FRA F 6180.117 (Rev. 1-5-12).doc safetydata.fra.dot.gov/officeofsafety/publicsite/forms.aspx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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	FRA-F-6180.117	Report of Railroad Trespasser Death	FRA F 6180.117 (Rev. 1-5-12).doc	http://safetydata.fra.dot.gov/officeofsafety/publicsite/forms.aspx	Yes	Yes	Paper Only

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	1,375	1,375
Annual IC Time Burden (Hours)	115	115
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.