PRA statement and pledge of confidentiality page

Burden Statement

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 subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is XXXX-XXX (Exp. Date XX/XX/XXXX). Public reporting of a near-miss is estimated to take approximately 30 minutes, including the time for reviewing instructions, completing and reviewing the report. Reporting any information to the SafeOCS system is voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: SafeOCS Data Program, Demetra Collia, US DOT/ BTS, 1200 New Jersey Avenue SE, Room E36-302, Washington, D.C. 20590 or email: [email protected].

Pledge of Confidentiality

The information you provide will be used for statistical purposes only. In accordance with the BTS confidentiality statute (49 U.S.C. 6307) and the Confidential Information Protection provisions of Title V, Subtitle A, Public Law 107-347, your responses will be kept confidential and will not be disclosed in identifiable form to anyone other than BTS employees or BTS agents such as telephone interviewers. In accordance with these confidentiality statutes, only statistical and non-identifying data will be made publicly available through reports. By law, every BTS employee and BTS agent has taken an oath of confidentiality and is subject to a jail term of up to 5 years, a fine of up to $250,000, or both if he or she discloses ANY identifiable information about the respondent. BTS will not release to BSEE/DOI or any other public or private entity any information that might reveal the identity of individuals or organizations mentioned in near-miss reports.

 I have read and understand the Burden Statement and Pledge of Confidentiality