Appendix C

OMB 2105-0529 2023 Supporting Statement Appendix C - MIS Form Proposed Revisions.pdf

Procedures for Transportation Drug and Alcohol Testing Program

Appendix C

OMB: 2105-0529

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Type of Test

Reasonable Susp./Cause

Return-to-Duty

Follow-Up

TOTAL
Specimen
Type

Pre-Employment
Urine
Oral Fluid
Total

Random
Urine
Oral Fluid
Total

Post-Accident
Urine
Oral Fluid
Total

Urine
Oral Fluid
Total
Urine
Oral Fluid
Total
Urine
Oral Fluid
Total
Urine
Oral Fluid
Total

12

Cancelled Results

Testing

10
11
Refusal Results

Submit To

Other Refusals To

Explanation

With No Medical

"Shy Bladder/Mouth" -

9

Substituted

8

Adulterated

7

Amphetamines

Positive For

6

Opioids

Positive For

5

PCP

Positive For

4

Cocaine

Positive For

3

Marijuana

Positive For

More Drugs

2

Results - For One Or

Verified Positive

1

Results

Verified Negative

3, 9, 10, 11, and 12]

the sum of Columns 2,

Results [Should equal

Total Number Of Test

III. Drug Testing Data
13


File Typeapplication/pdf
AuthorHuntley, Michael (FMCSA)
File Modified2023-10-02
File Created2023-08-01

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