Hazardous Materials Incidents Reports

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2137-0039 can be found here:

Documents and Forms

Document Name Document Type
5800.1 Reporting Instructions.pdf 5800.1 Reporting Instructions IC Document
HAZMAT Incident Reporting Form.pdf Hazmat Incident Reporting Form IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Hazardous Materials Incidents Reports	Agency IC Tracking Number:	2137-0039 Renewal

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 49 CFR 171.21 49 CFR 171.16 49 CFR 171.15

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title: Privacy Act Statement	FR Citation: 69 FR 19477

Number of Respondents: 1,781	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 33 %

	Approved	Previously Approved
Annual Number of Responses for this IC	17,810	17,810
Annual IC Time Burden (Hours)	23,746	23,746
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
5800.1 Reporting Instructions	5800.1 Reporting Instructions.pdf	06/15/2017
Hazmat Incident Reporting Form	HAZMAT Incident Reporting Form.pdf	06/15/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.