Information Collection Request

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

ICR 202212-2127-004 · OMB 2127-0754 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form NHTSA Form 1612 Level 2 ADAS/ADS Incident Report Form and Instruction Unchanged Available
Form NHTSA Form 1612 Level 2 ADAS/ADS Incident Reporting Form and Instruction Unchanged Repair queued
Form NHTSA Form 1612 ADS ADAS Incident Report Form Removed Available
Form NHTSA Form 1612 Monthly Reports Form Removed Repair queued
Form NHTSA Form 1612 ADS ADAS Incident Report Form Removed Available
Form NHTSA Form 1612 ADS one-day reports, update Form Removed Repair queued
Form NHTSA Form 1612 ADS ADAS Inicident Report Form Removed Available
Form NHTSA Form 1612 ADS one-day reports, initial Form Removed Repair queued
Form NHTSA Form 1612 ADS ADAS Incident Report Form Removed Available
Form NHTSA Form 1612 Level 2 ADAS one-day reports, update Form Removed Repair queued
Form NHTSA Form 1612 ADS ADAS Incident Report Form Removed Available
Form NHTSA Form 1612 Level 2 ADAS one-day reports, initial Form Removed Repair queued
PRA SS Part A ADS ADAS Incident Reporting_30Day_12.23.21_final (1).docx Supporting Statement A Uploaded 2022-12-19 Repair queued
First_Amended_SGO_2021_01_Final.pdf Supplementary Document Uploaded 2021-12-29 Repair queued
60 Day Notice_9.30.12_86 FR 54287.pdf Supplementary Document Uploaded 2021-12-29 Repair queued
30 Day Notice_12.29.21_86 FR 74217.pdf Supplementary Document Uploaded 2021-12-29 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
250893 Level 2 ADAS/ADS Incident Reporting Form and Instruction UnchangedLevel 2 ADAS/ADS Incident Report
250893 Level 2 ADAS/ADS Incident Reporting Form and Instruction Unchanged
248104 Setting Up MAP Account Removed
248103 Training Removed
248102 Monthly Reports Form RemovedADS ADAS Incident Report
248102 Monthly Reports Form Removed
248101 ADS one-day reports, update Form RemovedADS ADAS Incident Report
248101 ADS one-day reports, update Form Removed
248100 ADS one-day reports, initial Form RemovedADS ADAS Inicident Report
248100 ADS one-day reports, initial Form Removed
248099 Level 2 ADAS one-day reports, update Form RemovedADS ADAS Incident Report
248099 Level 2 ADAS one-day reports, update Form Removed
248098 Level 2 ADAS one-day reports, initial Form RemovedADS ADAS Incident Report
248098 Level 2 ADAS one-day reports, initial Form Removed

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2026 36 Months From Approved 03/31/2023
2,631 0 8,245
31,319 0 12,539
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
ADS one-day reports, initial NHTSA Form 1612
ADS one-day reports, update NHTSA Form 1612
Level 2 ADAS one-day reports, initial NHTSA Form 1612
Level 2 ADAS one-day reports, update NHTSA Form 1612
Level 2 ADAS/ADS Incident Reporting NHTSA Form 1612
Monthly Reports NHTSA Form 1612
Setting Up MAP Account
Training

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,631 8,245 0 2,631 -8,245 0
Annual Time Burden (Hours) 31,319 12,539 0 31,319 -12,539 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No