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Resolution of Medical Conflict
Medical Qualification Requirements
OMB: 2126-0006
IC ID: 216251
OMB.report
DOT/FMCSA
OMB 2126-0006
ICR 201607-2126-003
IC 216251
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2126-0006 can be found here:
2023-04-27 - No material or nonsubstantive change to a currently approved collection
2022-02-25 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Resolution of Medical Conflict
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Mandatory
CFR Citation:
49 CFR 391.41
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Transportation
Subfunction:
Ground Transportation
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
540,000
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
3
0
0
0
0
3
Annual IC Time Burden (Hours)
11
0
0
0
0
11
Annual IC Cost Burden (Dollars)
0
0
0
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.