Information Collection

Hazardous Materials Incidents Reports - Written and Electronic

IC 26730 under ICR 202606-2137-007 · OMB 2137-0039.

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
HAZMAT Incident Reporting Form.pdf Hazmat Incident Reporting Form	IC Document

IC Title:

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
	Requested	Previously Approved
Annual Number of Responses for this IC	22,608	22,608
Annual IC Time Burden (Hours)	20,397	20,397
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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

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

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