Information Collection

Ophthalmological Evaluation for Glaucoma

IC 211732 under ICR 202211-2120-005 · OMB 2120-0034.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2120-0034 can be found here:

Documents and Forms

Document Name Document Type
Form 8500-14 Ophthalmological Evaluation for Glaucoma Form and Instruction
8500-14 Ophthalmological Evaluation for Glaucoma 8500-14 with upd burden statement.pdf www.faa.gov/forms/index.cfm/go/document.information/documentID/185785 Form and Instruction
8500-14 Ophthalmological Evaluation for Glaucoma 8500-14 with upd burden statement.pdf www.faa.gov/forms/index.cfm/go/document.information/documentID/185785 Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Ophthalmological Evaluation for Glaucoma	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 14 CFR 67 14 CFR 61

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	8500-14	Ophthalmological Evaluation for Glaucoma	8500-14 with upd burden statement.pdf	https://www.faa.gov/forms/index.cfm/go/document.information/documentID/185785	Yes	Yes	Fillable Printable

Line of Business: Transportation

Subfunction: Air Transportation

Privacy Act System of Records
Title: Aviation Records on Individuals	FR Citation: 75 FR 68849

Number of Respondents: 6,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	6,000	6,000
Annual IC Time Burden (Hours)	1,500	1,500
Annual IC Cost Burden (Dollars)	60,930	60,930

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.