Form FRA Form No. 19 FRA Form No. 19 Report of Alteration or Welded or Riveted Repair

OMB No. 2130-0505

FRA Form 19

Report of

ALTERATION

or
Welded or Riveted REPAIR
Locomotive Initials ______________ Locomotive No. ____________; Boiler No. ____________;
Owned by: _______________________________________________________________________________
Operated by: _____________________________________________________________________________
Date work completed ________________
Description of work:

Stress Calculations:

Remarks:

Attach drawings used in the repair or alteration or make drawings on back of this form.
Work done by: ____________________________;

Certified by: _____________________________

Public reporting burden for this information collection is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. According to the Paperwork Reduction Act of 1995,
a federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with, a collection
of information unless it displays a currently valid OMB control number. The valid OMB control number for this information collection is 2130-0505. All responses to
this collection of information are mandatory. Send comments regarding this burden estimate or any other aspect of this collection, including suggestions for reducing this
burden to: Information Collection Officer, Federal Railroad Administration, 1200 New Jersey Ave., S.E., Washington D.C. 20590.

FRA Form No. 19

(01/09)

Expires 08/31/2018