Information Collection

225.21--Alternative record for illnesses claimed to be work related--Form FRA F 6180.107

IC 231040 under ICR 202506-2130-001 · OMB 2130-0500.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FRA F 6180.107 225.21--Alternative record for illnesses claimed to be work related--Form FRA F 6180.107	Form and Instruction
Form FRA F 6180.107 Alternate Record for Illness Claimed to Be Work Related 225.21--Alternative record for illnesses claimed to be work related--Form FRA F 6180.107	Form and Instruction
FRA F 6180.107 Alternate Record for Illness Claimed to Be Work Related FRA F 6180.107.pdf railroads.dot.gov/forms-guides-publications/forms/current-forms	Form and Instruction
FRA F 6180.107 Alternate Record for Illness Claimed to Be Work Related FRA F 6180.107.pdf railroads.dot.gov/forms-guides-publications/forms/current-forms	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation: 49 CFR 225

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
Form and Instruction	FRA F 6180.107			https://railroads.dot.gov/forms-guides-publications/forms/current-forms	Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 784

Number of Respondents for Small Entity: 734

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-150	150
Annual IC Time Burden (Hours)	-188	188
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.

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