FRA Change Request (Form OMB 83-C)

PAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/Subagency

OMB control number

Department of Transportation
Federal Railroad Administration

2

1

3

0

0

5

2

6

Enter only items that change
Current record
New record
Agency form number(s)

Annual reporting and recordkeeping hour
burden
Number of respondents
Total annual responses
Percent of these responses
collected electronically

%

%

Total annual hours

0

Difference
Explanation of difference
Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)
Total annualized Capital/Startup costs
Total annual costs (O&M)

0.00

Total annualized cost requested

0.00
0.00

Difference
Explanation of difference
Program change
Adjustment
Other changes**

TO SAVE PRINTING/STORAGE COSTS FOR 45,000 NEW ALCOHOL/DRUG FORMS (FRA F 6180.73/74/75) AND TO SAVE THESE
COSTS AT EVERY OMB RE-APPROVAL FOR THIS IC, FRA REQUESTS AN EXPIRATION DATE WAIVER ON THESE 3 FORMS.
Signature of Senior Official or designee:

Date:

For OIRA Use

05/05/2017
**This form cannot be used to extend an expiration date.
OMB FORM 83-C, 10/95

Reset

Adobe Professional 7.0