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Federal Railroad Administration
Alleged Violation Reporting Form

OMB Control No. 2130-0590

Public reporting burden for this information collection is estimated to average 10 minutes per response, including the time for searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. According to the Paperwork Reduction Act of 1995, 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 unless it displays a currently valid OMB control number. The valid OMB control number for this information collection is 2130-0590. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection, including suggestions for reducing this burden to: Information Collection Officer, Federal Railroad Administration, 1200 New Jersey Ave S.E., Washington D.C. 20590.

Your submission is voluntary and anonymous unless you choose to provide us with your contact information. Choosing not to provide your contact information may affect our ability to follow up with you on the status of the investigation and may prevent us from adequately investigating the alleged violation.

Our privacy policy can be viewed here.

Your Name:
Your Email:
Phone Number:
Preferred Contact Method:
Railroad or Company that Committed the Alleged Violation:
Type of Alleged Violation:
Date of Alleged Violation: Time of Alleged Violation:
Alleged Violation Location:
Please provide a description of the Alleged Violation:
FRA F 6180.151 (11-2010) OMB Control No. 230-0590 Approval Expires 12/31/2016
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