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Form Dot F 1385 - Drug And Alcohol Testing Mis Data Collection - U.s. Department Of Transportation - 2008 Page 2

PAPERWORK REDUCTION ACT NOTICE (as required by 5 CFR 1320.21)

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 Number for this information collection 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 and reviewing the

collection of information. All responses to this collection of 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, or

imprisonment for not more than 5 years, or both, to knowingly and willfully 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.

Form Dot F 1385 - Drug And Alcohol Testing Mis Data Collection - U.s. Department Of Transportation - 2008 Page 2