Information Collection

Ophthalmological Evaluation for Glaucoma

IC 211732 under ICR 202002-2120-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 8500-14 Ophthalmological Evaluation for Glaucoma	Form and Instruction
8500-14 Ophthalmological Evaluation for Glaucoma 8500-14 with upd burden statement.pdf www.faa.gov/forms/index.cfm/go/document.information/documentID/185785	Form and Instruction

IC Title:

Ophthalmological Evaluation for Glaucoma

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 14 CFR 67 14 CFR 61

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 and Instruction	8500-14	Ophthalmological Evaluation for Glaucoma	8500-14 with upd burden statement.pdf	https://www.faa.gov/forms/index.cfm/go/document.information/documentID/185785	Yes	Yes	Fillable Printable

Line of Business: Transportation

Subfunction: Air Transportation

Privacy Act System of Records

Title: Aviation Records on Individuals

FR Citation: 75 FR 68849

Number of Respondents: 6,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	6,000	-3,000	9,000
Annual IC Time Burden (Hours)	1,500	-750	2,250
Annual IC Cost Burden (Dollars)	60,930	60,930	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.