Information Collection

Drug and Alcohol records reporting form (web #1)

IC 245255 under ICR 202012-2120-002 · OMB 2120-0607.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2120-0607 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Drug and Alcohol Records IC list.docx	Other-Collection fields
Drug and Alcohol Records IC list.docx	Other-Collection fields
D&A Record Collection Form.JPG	Other-web form
D&A Record Collection Form.JPG	Other-web form

IC Title:

Drug and Alcohol records reporting form (web #1)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 14 CFR 135 14 CFR 121 14 CFR 111 14 CFR 91 14 CFR 125

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
Other-Collection fields			Drug and Alcohol Records IC list.docx		Yes	Yes	Fillable Fileable
Other-web form			D&A Record Collection Form.JPG		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Air Transportation

Privacy Act System of Records

Title: DOT/ALL 13 Internet/Intranet Activity and Access Records

FR Citation: 67 FR 30758

Number of Respondents: 3,220

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	3,220	3,120	100
Annual IC Time Burden (Hours)	1,394	1,369	25
Annual IC Cost Burden (Dollars)	0	0	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.