Monthly Reports

Incident Reporting for Automated Driving Systems (ADS) and Level 2 Advanced Driver Assistance Systems (ADAS)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2127-0754 can be found here:

Documents and Forms

Document Name Document Type
Form NHTSA Form 1612 Monthly Reports Form
NHTSA Form 1612 ADS ADAS Incident Report [STATIC IMAGE + WATERMARK] - NHTSA Form 1612 - ADS ADAS Incident Report Form.png Form

Information Collection (IC) Details

IC Title:	Monthly Reports	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation: 49 CFR 510

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NHTSA Form 1612	ADS ADAS Incident Report	[STATIC IMAGE + WATERMARK] - NHTSA Form 1612 - ADS ADAS Incident Report Form.png		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 110	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-1,320	1,320
Annual IC Time Burden (Hours)	-1,339	1,339
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.