Information Collection

IC-6: Medical Review Officer (MRO) Complaints

IC 250977 under ICR 202112-2126-003 · OMB 2126-0067.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2126-0067 can be found here:

Documents and Forms

Document Name Document Type
Form NCCDB Form 6 IC-6: Medical Review Officer (MRO) Complaints Form and Instruction
NCCDB Form 6 Medical Review Officer (MRO) Complaints NCCDB Industry Complaint Entry January 2022.docx nccdb.fmcsa.dot.gov/nccdb/home.aspx Form and Instruction
NCCDB Form 6 Medical Review Officer (MRO) Complaints NCCDB Industry Complaint Entry January 2022.docx nccdb.fmcsa.dot.gov/nccdb/home.aspx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	IC-6: Medical Review Officer (MRO) Complaints	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NCCDB Form 6	Medical Review Officer (MRO) Complaints	NCCDB Industry Complaint Entry January 2022.docx	https://nccdb.fmcsa.dot.gov/nccdb/home.aspx	Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title: Privacy Act of 1974: System of Records	FR Citation: 75 FR 27051

Number of Respondents: 6	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	6	6
Annual IC Time Burden (Hours)	2	2
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.