Form 3-2541: 6(a)(2) Adverse Incident Report

Online Program Management System for Carbon Dioxide-Carp

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1018-0182 can be found here:

Documents and Forms

Document Name Document Type
Form 3-2541 Form 3-2541: 6(a)(2) Adverse Incident Report Form
3-2541 6(a)(2) Adverse Incident Report 3-2541 6(a)(2) Adverse Incident Report Form 05172021.docx fwsepermits.servicenowservices.com/fws/ Form
3-2541 6(a)(2) Adverse Incident Report 3-2541 6(a)(2) Adverse Incident Report Form 05172021.docx fwsepermits.servicenowservices.com/fws/ Form

Information Collection (IC) Details

IC Title:	Form 3-2541: 6(a)(2) Adverse Incident Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	3-2541	6(a)(2) Adverse Incident Report	3-2541 6(a)(2) Adverse Incident Report Form 05172021.docx	https://fwsepermits.servicenowservices.com/fws/	Yes	Yes	Fillable Fileable Signable

Line of Business: Natural Resources

Subfunction: Conservation, Marine and Land Management

Privacy Act System of Records
Title: INTERIOR/FWS-21, Permits System	FR Citation: 68 FR 52610

Number of Respondents: 1	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.