The following form is the MIS Data Collection form required for use to report calendar year MIS data. The instructions for this form are found at https://www.transportation.gov/odapc.

PAPERWORK REDUCTION ACT NOTICE

(as required by 5 CFR 1320.21)

Visit www.dotcfr.com to download a fullsize PDF of this form

A federal agency may not conduct or sponsor, and a person is not required to respond to nor shall a person be subject to, a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB control number.The OMB control umber for this information is 2105-0529. Public reporting for this collection of information is estimated to be approximately 90 minutes per response, including the time for reviewing instructions, completing the review and collection of information. All responses to collection of this information are mandatory. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, U.S. Department of Transportation, Office of Drug and Alcohol Policy and Compliance, 1200 New Jersey Avenue, SE, Suite W62-300, Washington, D.C. 20590.

Title 18, USC section 1001, makes it a criminal offense subject to a maximum fine of $10,000.00, or imprisonment for not more that 5 years, or both, to knowingly and willingly make or cause to be made any false or fraudulent statements of representations in any matter within the jurisdiction of any agency of the United States.

[84 FR 16773, Apr. 23, 2019]