Information Collection

BasicMed Comprensive Medical Examination Checklist

IC 226106 under ICR 201703-2120-004 · OMB 2120-0770.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2120-0770 can be found here:

Documents and Forms

Document Name Document Type
Form 8700-2 BasicMed Comprensive Medical Examination Checklist Form and Instruction
8700-2 BasicMed Comprehensive Medical Examination Checklist FAA Form 8700-2 - BasicMed Comprehensive Medical Examination Checklist.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	BasicMed Comprensive Medical Examination Checklist	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	8700-2	BasicMed Comprehensive Medical Examination Checklist	FAA Form 8700-2 - BasicMed Comprehensive Medical Examination Checklist.docx	TBD	Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Air Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 453,993	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	453,993	453,993
Annual IC Time Burden (Hours)	158,898	158,898
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.