Information Collection

Monthly Reports

IC 248102 under ICR 202212-2127-004 · OMB 2127-0754.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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
NHTSA Form 1612 ADS ADAS Incident Report [STATIC IMAGE + WATERMARK] - NHTSA Form 1612 - ADS ADAS Incident Report Form.png	Form

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.