Information Collection

225.19(d)--Death, injury, or occupational illness--Form FRA F 6180.55a)

IC 231032 under ICR 202104-2130-002 · OMB 2130-0500.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2130-0500 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FRA F 6180.55a 225.19(d)--Death, injury, or occupational illness--Form FRA F 6180.55a)	Form and Instruction
FRA F 6180.55a Railroad Injury and Illness Summary FRA F 6180.55a.pdf railroads.dot.gov/forms-guides-publications/forms/current-forms	Form and Instruction
FRA F 6180.55a Railroad Injury and Illness Summary FRA F 6180.55a.pdf railroads.dot.gov/forms-guides-publications/forms/current-forms	Form and Instruction

IC Title:

225.19(d)--Death, injury, or occupational illness--Form FRA F 6180.55a)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 49 CFR 225

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	FRA F 6180.55a	Railroad Injury and Illness Summary	FRA F 6180.55a.pdf	https://railroads.dot.gov/forms-guides-publications/forms/current-forms	Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 765

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10,301	-76	10,377
Annual IC Time Burden (Hours)	11,636	483	11,153
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.