Information Collection

Emergency Responders - Consent Form

IC 212110 under ICR 201312-2137-001 · OMB 2137-0034.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2137-0034 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Emergency Responders - Consent Form.docx	Other-Emergency Respondres - Consent

IC Title:

Emergency Responders - Consent Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 49 CFR 172.201 49 CFR 172.202 49 CFR 172.200

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
Other-Emergency Respondres - Consent Form			Emergency Responders - Consent Form.docx		Yes	Yes	Fillable Printable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 24

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	24	24
Annual IC Time Burden (Hours)	2	2
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.