Drug and Alcohol records reporting form (web #1)

Pilot Records Improvement Act of 1996/ Pilot Record Database

Documents and Forms

Document Name Document Type
Drug and Alcohol Records IC list.docx Other-Collection fields
Drug and Alcohol Records IC list.docx Other-Collection fields
D&A Record Collection Form.JPG Other-web form
D&A Record Collection Form.JPG Other-web form

Information Collection (IC) Details

IC Title:	Drug and Alcohol records reporting form (web #1)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 14 CFR 135 14 CFR 121 14 CFR 111 14 CFR 91 14 CFR 125

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Collection fields			Drug and Alcohol Records IC list.docx		Yes	Yes	Fillable Fileable
Other-web form			D&A Record Collection Form.JPG		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Air Transportation

Privacy Act System of Records
Title: DOT/ALL 13 Internet/Intranet Activity and Access Records	FR Citation: 67 FR 30758

Number of Respondents: 2,129	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,767	-1,453	3,220
Annual IC Time Burden (Hours)	106	-1,288	1,394
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.