APPLICATION FOR EXEMPTION RENEWAL DOT 2167

ICR 198306-2137-002

OMB: 2137-0030

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
142995
Migrated
ICR Details
2137-0030 198306-2137-002
Historical Active 198107-2137-004
DOT/PHMSA
APPLICATION FOR EXEMPTION RENEWAL DOT 2167
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 08/08/1983
Retrieve Notice of Action (NOA) 06/01/1983
  Inventory as of this Action Requested Previously Approved
08/31/1986 08/31/1986
1,000 0 0
1,000 0 0
0 0 0

NEEDED TO OBTAIN SAFETY ANALYSIS FROM EXEMPTION HOLDERS WHO WISH TO RENEW THEIR EXEMPTION. USED BY STAFF OF MTB TO EVALUATE THE RENEWAL REQUEST TO DETERMINE IF EXEMPTION SHOULD BE RENEWED OR RENEWAL REQUEST DENIED.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR EXEMPTION RENEWAL DOT 2167

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,000 0 0 0 1,000 0
Annual Time Burden (Hours) 1,000 0 0 0 1,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/01/1983


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