Medical Review Guidelines and Medical Advisory Board Practices

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NHTSA Form 1228 Medical Review Guidelines and Medical Advisory Board Practices	Form and Instruction	New	Available
US Code_RPierce.pdf	Supplementary Document	Uploaded 2014-04-11	Available
DTNH22-09-D-00135TO8 - Intro Letter.docx	Supplementary Document	Uploaded 2014-04-11	Available
DTNH22-09-D-00135_TO8 - Section B OMB v1.3.1.docx	Supporting Statement B	Uploaded 2014-12-11	Available
DTNH22-09-D-00135-TO8 - Section A OMB v1.3.1.docx	Supporting Statement A	Uploaded 2014-12-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
211232	Medical Review Guidelines and Medical Advisory Board Practices	Form and Instruction	New

ICR Details

OMB Control No: 2127-0705	ICR Reference No: 201404-2127-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOT/NHTSA	Agency Tracking No:
Title: Medical Review Guidelines and Medical Advisory Board Practices
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/07/2015
	Date Received in OIRA: 05/15/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2018	36 Months From Approved
Responses	51	0	0
Time Burden (Hours)	255	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The National Highway Traffic Safety Administration (NHTSA) of the U.S. Department of Transportation (USDOT) is seeking approval from the Office of Management and Budget (OMB) to conduct a census survey of the medical review process in each of the 51 driver licensing agencies, to document the structures, guidelines, and processes used by the 51 driver licensing agencies in the United States

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Authorizing Statute(s): US Code: 23 USC Chapter 4, Section 403 Name of Law: Moving Ahead for Progress in the 21st Century Act of 2012
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 65038	10/20/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 5018	01/30/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Medical Review Guidelines and Medical Advisory Board Practices	NHTSA Form 1228	DRIVER MEDICAL REVIEW PRACTICES

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	51	0	0	51	0	0
Annual Time Burden (Hours)	255	0	0	255	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a one-time request that will create a program change of adding an additional 255 burden hours to NHTSA's overall total. This request does not produce any repeating annual reporting, record-keeping burden, or cost burden.

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Annual Cost to Federal Government: $61,504

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/15/2014

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