Information Collection

Fallen Highway Worker Recognition Form

IC 279127 under ICR 202408-2125-001 · OMB 2125-0628.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Fallen Highway Worker Recognition Form_021826.pdf	Other-Collection Form
FHWA Generic Clearance Submission Form- Fallen Worker Info - 2-19-26.docx FHWA Generic Clearance Submission Form	IC Document
Fast-Track Generic Clearance Checklist-Fallen Worker Recognition- 2-19-26.docx Generic Clearance Checklist	IC Document
2125-0628_Burden Statement-Worker Fatality Info-02-19-2026.docx Burden Statement- Fallen Highway Worker Recognition	IC Document

IC Title:

Agency IC Tracking Number:

Ready for Submission

IC Status: New

Obligation to Respond: Voluntary

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
Other-Collection Form					Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
FHWA Generic Clearance Submission Form		02/19/2026
Generic Clearance Checklist		02/19/2026
Burden Statement- Fallen Highway Worker Recognition		02/19/2026

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

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