Information Collection

Ophthalmological Evaluation for Glaucoma

IC 211732 under ICR 201703-2120-001 · OMB 2120-0034.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2120-0034 can be found here:

Documents and Forms

Document Name Document Type
Form 8500-14 Ophthalmological Evaluation for Glaucoma Form
8500-14 Ophthalmological Evaluation for Glaucoma 8500-14_PRA revised.pdf medxpress.faa.gov/ Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Ophthalmological Evaluation for Glaucoma	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 14 CFR 61 14 CFR 67

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	8500-14	Ophthalmological Evaluation for Glaucoma	8500-14_PRA revised.pdf	https://medxpress.faa.gov/	Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Air Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	9,000	9,000
Annual IC Time Burden (Hours)	2,250	2,250
Annual IC Cost Burden (Dollars)	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.