OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Non-Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5872

IC 260909 under ICR 202507-2126-011 · OMB 2126-0081.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Non-Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5872
 
No Modified
 
Voluntary
 
49 CFR 49 CFR § 391.41(b)(1-13)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form MCSA-5872 Non-Insulin-Treated Diabetes Mellitus Assessment Form MCSA-5872 1-26-24 508.pdf https://www.fmcsa.dot.gov/regulations/medical/non-insulin-treated-diabetes-mellitus-assessment-form-mcsa-5872-optional Yes Yes Fillable Fileable Signable

Transportation Ground Transportation

 

242,057 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 242,057 0 0 0 0 242,057
Annual IC Time Burden (Hours) 32,274 0 0 0 0 32,274
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].