Pilot/Operator Aircraft Accident/Incident Report

OMB Control No: 3147-0001	ICR Reference No: 201710-3147-001
Status: Historical Active	Previous ICR Reference No: 201706-3147-001
Agency/Subagency: NTSB	Agency Tracking No: 6120.1
Title: Pilot/Operator Aircraft Accident/Incident Report
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 10/20/2017
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/16/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/16/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2018	6 Months From Approved
Responses	1,800	0	0
Time Burden (Hours)	1,800	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The pilot/operator accident and incident report form is an information collection tool. The form is completed by the pilot, the operator, or their representative who was involved in an accident or incident. The pilot/operator acquires and submits the form by email, mail, or fax. The form is available at www.ntsb.gov.

Emergency Justfication: In June 2017, OMB granted a three-month extension of NTSB Form 6120.1. OMB is permitted to extend Control Numbers by up to six months. For the reasons stated below, the NTSB is requesting that OMB grant the NTSB the remaining available 90 days. The NTSB published the first required Federal Register notice describing its intent to renew Form 6120.1.. 82 FR 82707, Sept. 11, 2017. The NTSB has already received comments from industry stakeholders about how to reduce the burdens involved in obtaining the information sought in Form 6120.1. The NTSB is agreeable to reducing the burdens and tailoring the form to the needs of each accident investigation about which the form is used to collect information. The NTSB anticipates additional comments about how to tailor and modernize the form, and intends to review and incorporate the comments as appropriate. Given that the NTSB anticipates modifying the form to reduce the burdens, consistent with industry input, additional time is requested to give the comments the attention they deserve and to be able to modify the form accordingly. The form is an 11-page form containing eighteen categories of information to be provided by aircraft operators. Each category asks for several pieces of information in short answer form or by selecting options from a list. Given the form's level of detail and format, tailoring the form will likely require coordination with the NTSB Office of Chief Information Officer. Thus, NTSB requests that the form continue in effect for the remaining available 90 days in order to incorporate anticipated burden reductions.

---

Authorizing Statute(s): US Code: 49 USC 1101-1155 Name of Law: Independent Bd Safety Act of 1974; National Transportation Safety Board Reauthorization Act of 2006

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 42707	09/11/2017
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title Form No. Form Name NTSB Form 6120.1: Pilot/Operator Aircraft Accident/Incident Report NTSB 6120.1 Pilot/Operator Aircraft Accident Incident Report

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,800	0	0	0	0	1,800
Annual Time Burden (Hours)	1,800	0	0	0	0	1,800
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $651,103

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Matthew McKenzie 202 314-6630 [email protected]

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
		(a) It is necessary for the proper performance of agency functions;
		(b) It avoids unnecessary duplication;
		(c) It reduces burden on small entities;
		(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
		(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
		(f) It indicates the retention periods for recordkeeping requirements;
		(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
			(i) Why the information is being collected;
			(ii) Use of information;
			(iii) Burden estimate;
			(iv) Nature of response (voluntary, required for a benefit, or mandatory);
			(v) Nature and extent of confidentiality; and
			(vi) Need to display currently valid OMB control number;
		(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
		(i) It uses effective and efficient statistical survey methodology (if applicable); and
		(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date: 10/16/2017

---