Information Necessary to Obtain
Federal Railroad Administration Movement Approval

[Collection of this information is authorized under OMB Control Nos. 2137-0557 and 2137-0559.]

Cover Letter    |    Electronic OTMA Application (Rel. v3.0)    |    Electronic Submissions Instructions

Action:
Date of Application: Approval Number: TBD
Company Name: *
Mailing Address: *
City: * State: * Zip: *
Click here if foreign address
Company Fax (facsimile) #:
Company Contact: *
Title / Position: *
Contact Telephone # * Ext. Contact Email Address: *
Tank Car Owner: *
Contact Name: *
Contact Telephone # * Ext. Contact Email Address: *
Reporting Mark & Number: * -
Type of Rail Car/Bulk Package: *
DOT tank car/bulk package specification (if other, specify): *
Special Permit Packaging? If so, enter the special permit number
(e.g., SP-00001)
Complete Hazardous Materials Description: Is the packaging *  
Note: If "Cleaned and Empty" is selected, the cleaning certificate must be attached.
DOT Proper Shipping Name: *
Technical Name (Chemical Name):
Click here to enter a Non-Hazardous Materials description
DOT Hazard Class: * Subsidiaries:
UN/NA Identification #: * P.G. Number: *
Where did this shipment originate?
Facility: *
City: * State: * Click here if foreign address
Original Shipper Point of Contact
Name: * Phone #: * Email Address: *
Present Location of Car
Check here if address and contact information is the same as shipment origination provided in the previous section
Facility or Carrier: *
City: * State: * Click here if foreign address
Present Location Point of Contact
Name: * Phone #: * Email Address: *
Planned Destination 1 of this move
Facility: *
City: * State: * Click here if foreign address
Planned Destination 1 Point of Contact
Name: * Phone #: * Email Address: *
Total mileage from present location to destination 1: *  miles
Planned rail route: *
Planned Destination 2 of this move
Facility:
City: State: Click here if foreign address
Planned Destination 2 Point of Contact
Name: Phone #: Email Address:
Total mileage from destination 1 to destination 2:  miles
Planned rail route:
Planned Destination 3 of this move
Facility:
City: State: Click here if foreign address
Planned Destination 3 Point of Contact
Name: Phone #: Email Address:
Total mileage from destination 2 to destination 3:  miles
Planned rail route:
Approximate total mileage of this movement:  miles
If more than 30 days will be required to complete movement sought under this approval. Please explain:
What is the defective condition? *
Defective Conditions: *   Selected Defective Conditions:


Provide a detailed explanation of the defective condition:
Explain, with supporting documentation, the measures you are taking to ensure the safe movement of this car: *
***** Note: Attach with this application a copy of the original shipping paper. *****
*
I acknowledge that failure to accurately represent the defective condition of the tank car, failure to disclose additional defective conditions, or failure to comply with the conditions and limitations set forth in One-Time Movement Approval Procedures (HMG-127) is considered non-compliance with 49 CFR § 174.50, and appropriate enforcement action may be taken.
INCOMPLETE OR INACCURATE INFORMATION WILL RESULT IN DELAY PROCESSING!
Enter code as shown: *