Information Collection

Employer documentation of refusal to provide blood, breath urine specimens for chemical test

IC 185219 under ICR 202306-1625-002 · OMB 1625-0001.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
1625-0001_Inst_r9_2021-inv.docx	Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 46 CFR 4.06

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
Instruction			1625-0001_Inst_r9_2021-inv.docx		Yes	Yes	Printable Only

Line of Business: Transportation

Subfunction: Water Transportation

Privacy Act System of Records

Title: DHS/USCG-013 Marine Information for Safety and Law Enforcement (MISLE)

FR Citation: 74 FR 30305

Number of Respondents: 1

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	1	1
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.