Information Collection

Hazardous Materials Incidents Reports - Written and Electronic

IC 26730 under ICR 202306-2137-002 · OMB 2137-0039.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2137-0039 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
5800.1 Reporting Instructions.pdf 5800.1 Reporting Instructions	IC Document
5800.1 Reporting Instructions.pdf 5800.1 Reporting Instructions	IC Document
HAZMAT Incident Reporting Form.pdf Hazmat Incident Reporting Form	IC Document
HAZMAT Incident Reporting Form.pdf Hazmat Incident Reporting Form	IC Document

IC Title:

Hazardous Materials Incidents Reports - Written and Electronic

Agency IC Tracking Number:

2137-0039 Renewal

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 49 CFR 171.16

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

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title: Privacy Act Statement

FR Citation: 69 FR 19477

Number of Respondents: 338

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 71 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	22,608	2,450	20,158
Annual IC Time Burden (Hours)	20,397	1,535	18,862
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
5800.1 Reporting Instructions	5800.1 Reporting Instructions.pdf	06/15/2017
Hazmat Incident Reporting Form	HAZMAT Incident Reporting Form.pdf	06/15/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.