Medical Standards and Certification

Forms and Documents

Document Name	Status
Form 8500-14 Ophthalmological Evaluation for Glaucoma Form	New
Form 8500-8 Application for Airman Medical Certificate or Airman Medical and Student Pilot Certificate Form and Instruction	Modified
Form 8500-20 Medical Exemption Petition Form	Removed
Form 8500-7 Report of Eye Evaluation, Ophthalmologic Evaluation for Glaucoma Form	Modified
2120-0034 2014.doc Supporting Statement A	2014-05-28

IC Document Collections

IC ID	Document Title	Status
211732	Ophthalmological Evaluation for Glaucoma Form	New
196926	Application for Airman Medical Certificate or Airman Medical and Student Pilot Certificate Form and Instruction	Modified
196925	Medical Exemption Petition Form	Removed
196924	Report of Eye Evaluation, Ophthalmologic Evaluation for Glaucoma Form	Modified

ICR Details

OMB Control No: 2120-0034	ICR Reference No: 201405-2120-003
Status: Historical Active	Previous ICR Reference No: 201103-2120-001
Agency/Subagency: DOT/FAA	Agency Tracking No:
Title: Medical Standards and Certification
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/15/2015
	Date Received in OIRA: 09/02/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	36 Months From Approved	05/31/2015
Responses	414,300	0	412,226
Time Burden (Hours)	598,950	0	577,982
Cost Burden (Dollars)	46,367,100	0	33,440,000

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Abstract: The DOT/FAA certification program is implemented by Title 14 CFR parts 61 and 67. The Parts prescribes minimum airman medical standards, and duration of a medical certificate. Information collected substantiates the applicant's eligibility.

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Authorizing Statute(s): US Code: 49 USC 44701 Name of Law: General requirements
   US Code: 49 USC 44702 Name of Law: Issuance of certificates
   US Code: 49 USC 44703 Name of Law: Airman certificates
   US Code: 49 USC 44709 Name of Law: Amendments, modifications, suspensions, and revocations of certificates
   US Code: 49 USC 40113 Name of Law: Administrative
  

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:
	79 FR 8233	02/11/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 25172	05/02/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Report of Eye Evaluation, Ophthalmologic Evaluation for Glaucoma	8500-7	Report of Eye Evaluation
Application for Airman Medical Certificate or Airman Medical and Student Pilot Certificate	8500-8	Application for Airman Medical Certificate or Airman Medical and Student Pilot Certificate
Medical Exemption Petition	8500-20	Medical Exemption Petition
Ophthalmological Evaluation for Glaucoma	8500-14	Ophthalmological Evaluation for Glaucoma

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ICR Summary 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	414,300	412,226	0	-622	2,696	0
Annual Time Burden (Hours)	598,950	577,982	0	-81	21,049	0
Annual Cost Burden (Dollars)	46,367,100	33,440,000	0	0	12,927,100	0

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

Burden Increase Due to:

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

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The number of applicants and the applicants cost per hour has increased since the last submission. The average cost of a basic medical examination has been adjusted for inflation (from $88.00 to $117.00). With full automation, the forms are no longer printed and mailed. A fourth form, FAA Form-8500-20, is no longer used and has been cancelled.

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Annual Cost to Federal Government: $2,926,014

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 09/02/2014

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