Information Collection

Accident/Incident Reporting and Recordkeeping

IC 26389 under ICR 201508-2130-002 · OMB 2130-0500.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2130-0500 can be found here:

Documents and Forms

Document Name Document Type
Form FRA F 6180.39i Accident/Incident Reporting and Recordkeeping Form
April 24, 2015, FR Notice (60-Day).pdf htttp://www.gpo.gov Instruction
FRA F 6180.39i Railroad Accident/Incident Notification and Initial Inve FRA F 6180.39i.pdf safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp Form
FRA F 6180.55 Railroad Injury and Illness Summary FRA F 6180.55 (8-10).pdf safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx Form
FRA F 6180.55 Railroad Injury and Illness Summary Changes 6180.55.pdf safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx Form
FRA F 6180.55a Railroad Injury and Illness Summary FRA F 6180.55a (8-10).pdf safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx Form
FRA F 6180.56 Annual Railroad Report of Employee Hours and Casualties, FRA F 6180.56 (8-10).pdf safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx Form
FRA F 6180.57 Highway-Rail Grade Crossing Accident/Incident Report FRA F 6180.57 (8-10).pdf safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx Form
FRA F 6180.78 Notice to Railroad Employee Involved in Rail Equipment A FRA F 6180.78 (8-10).pdf safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx Form
FRA F 6180.81 Employee Human Factor Attachment FRA F 6180.81 (8-10).pdf safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx Form
FRA F 6180.98 Initial Rail Equipment Accident/Incident Record fra f 6180.97 (8-10).pdf safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx Form
FRA F 6180.98 Railroad Employee Injury and/or Illness Record FRA F 6180.98 (8-10).pdf safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx Form
FRA F 6180.107 Alternative Record for Illnesses Claimed to Be Work-Rela FRA F 6180.107 (8-10).pdf safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx Form
FRA F 6180.150 Highway User Injury Inquiry Form FRA F 6180.150 (8-10).doc safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx Form
FRA F 6180.54 Rail Equipment Accident/Incident Report F6180_54_Expires05312017.pdf safetydata.fra.dot.gov/officeofsafety/Publicsite/Forms.aspx Form
Draft FRA F 6180,5 Rail Equipment Accident/Incident Report Draft Rev PRA Statement F6180_54_Expires05312017.pdf safetydata.fra.dot.gov/officeofsafety/Publicsite/Forms.aspx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Accident/Incident Reporting and Recordkeeping	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 49 CFR 225

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FRA F 6180.39i	Railroad Accident/Incident Notification and Initial Investigation Report	FRA F 6180.39i.pdf	http://safetydata.fra.dot.gov/officeofsafety/Forms/Default.asp	Yes	Yes	Fillable Printable
Form	FRA F 6180.55	Railroad Injury and Illness Summary	FRA F 6180.55 (8-10).pdf	http://safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx	Yes	Yes	Fillable Printable
Form	FRA F 6180.55	Railroad Injury and Illness Summary	Changes 6180.55.pdf	http://safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx	Yes	Yes	Fillable Printable
Form	FRA F 6180.55a	Railroad Injury and Illness Summary	FRA F 6180.55a (8-10).pdf	http://safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx	Yes	Yes	Fillable Printable
Form	FRA F 6180.56	Annual Railroad Report of Employee Hours and Casualties, By State	FRA F 6180.56 (8-10).pdf	http://safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx	Yes	Yes	Fillable Printable
Form	FRA F 6180.57	Highway-Rail Grade Crossing Accident/Incident Report	FRA F 6180.57 (8-10).pdf	http://safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx	Yes	Yes	Fillable Printable
Form	FRA F 6180.78	Notice to Railroad Employee Involved in Rail Equipment Accident/Incident Attributed to Employee Human Factor	FRA F 6180.78 (8-10).pdf	http://safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx	Yes	Yes	Fillable Printable
Form	FRA F 6180.81	Employee Human Factor Attachment	FRA F 6180.81 (8-10).pdf	http://safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx	Yes	Yes	Fillable Printable
Form	FRA F 6180.98	Initial Rail Equipment Accident/Incident Record	fra f 6180.97 (8-10).pdf	http://safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx	Yes	Yes	Fillable Printable
Form	FRA F 6180.98	Railroad Employee Injury and/or Illness Record	FRA F 6180.98 (8-10).pdf	http://safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx	Yes	Yes	Fillable Printable
Form	FRA F 6180.107	Alternative Record for Illnesses Claimed to Be Work-Related	FRA F 6180.107 (8-10).pdf	http://safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx	Yes	Yes	Fillable Printable
Form	FRA F 6180.150	Highway User Injury Inquiry Form	FRA F 6180.150 (8-10).doc	http://safetydata.fra.dot.gov/officeofsafety/publicsite/FormsPub.aspx	Yes	Yes	Fillable Printable
Form	FRA F 6180.54	Rail Equipment Accident/Incident Report	F6180_54_Expires05312017.pdf	http://safetydata.fra.dot.gov/officeofsafety/Publicsite/Forms.aspx	Yes	Yes	Fillable Printable
Form	Draft FRA F 6180,54 w/Rev. Public Protection Stmnt	Rail Equipment Accident/Incident Report	Draft Rev PRA Statement F6180_54_Expires05312017.pdf	http://safetydata.fra.dot.gov/officeofsafety/Publicsite/Forms.aspx	Yes	Yes	Fillable Printable
Instruction			April 24, 2015, FR Notice (60-Day).pdf	htttp://www.gpo.gov	Yes	Yes	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 790	Number of Respondents for Small Entity: 665

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 58 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	103,976	0	103,976
Annual IC Time Burden (Hours)	39,058	30	39,028
Annual IC Cost Burden (Dollars)	0	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.