Information Collection

Accident/Incident Reporting and Recordkeeping

IC 26389 under ICR 201702-2130-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form FRA F 6180.55 Accident/Incident Reporting and Recordkeeping	Form
April 24, 2015, FR Notice (60-Day).pdf htttp://www.gpo.gov	Instruction
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 6180.55a 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 6180.107 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

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
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 6180.55a	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 6180.107	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
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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	103,976	103,976
Annual IC Time Burden (Hours)	39,058	39,058
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.