Information Collection

BasicMed Comprensive Medical Examination Checklist - Pilot

IC 226106 under ICR 202302-2120-002 · OMB 2120-0770.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2120-0770 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 8700-2 BasicMed Comprensive Medical Examination Checklist - Pilot	Form and Instruction
8700-2 BasicMed Comprehensive Medical Examination Checklist FAA_Form_8700-2.pdf www.faa.gov/documentLibrary/media/Form/FAA_Form_8700-2.pdf	Form and Instruction
8700-2 BasicMed Comprehensive Medical Examination Checklist FAA_Form_8700-2.pdf www.faa.gov/documentLibrary/media/Form/FAA_Form_8700-2.pdf	Form and Instruction

IC Title:

BasicMed Comprensive Medical Examination Checklist - Pilot

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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 and Instruction	8700-2	BasicMed Comprehensive Medical Examination Checklist	FAA_Form_8700-2.pdf	https://www.faa.gov/documentLibrary/media/Form/FAA_Form_8700-2.pdf	Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Air Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	12,500	0	12,500
Annual IC Time Burden (Hours)	6,250	-3,125	9,375
Annual IC Cost Burden (Dollars)	0	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.