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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Emergency Responders - Consent Form.docx Other-Emergency Respondres - Consent

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.