Form FRA F 6180.151 FRA F 6180.151 Alleged Violation Reporting Form

Federal Railroad Administration
Alleged Violation Reporting Form
OMB Control No. 2130-0590
Public reporting burden for this information collection is estimated to average 10 minutes per response, including the time for 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, a federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person
be subject to a penalty for failure to comply with, a collection of information unless it displays a currently valid OMB control number. The valid
OMB control number for this information collection is 2130-0590. All responses to this collection of information are voluntary. Send comments
regarding this burden estimate or any other aspect of this collection, including suggestions for reducing this burden to: Information Collection
Officer, Federal Railroad Administration, 1200 New Jersey Ave S.E., Washington D.C. 20590.

Your submission is voluntary and anonymous unless you choose to provide us with
your contact information. Choosing not to provide your contact information may affect our
ability to follow up with you on the status of the investigation and may prevent us from
adequately investigating the alleged violation.
Our privacy policy can be viewed at http://www.fra.dot.gov/pages/9.shtml .
Your Name:
Your Email:
Phone Number:
Preferred Contact
Method:

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Email

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Phone

Railroad or Company that
Committed the Alleged
Violation:
Type of Alleged Violation: Select...
Date of Alleged Violation:

Time of Alleged
Violation:

Alleged Violation
Location:
Please provide a
description of the Alleged
Violation:

FRA F 6180.151 (11-2010)

OMB Control No. 2130-0590 Approval Expires 12/31/2013