SUBMISSION OF ELIGIBILITY STATEMENT FOR UTILITY ADJUSTMENTS

ICR 198904-2125-007

OMB: 2125-0515

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
173054
Migrated
ICR Details
2125-0515 198904-2125-007
Historical Active 198904-2125-004
DOT/FHWA
SUBMISSION OF ELIGIBILITY STATEMENT FOR UTILITY ADJUSTMENTS
No material or nonsubstantive change to a currently approved collection   No
Emergency 04/06/1989
Approved with change 04/06/1989
Retrieve Notice of Action (NOA) 04/06/1989
  Inventory as of this Action Requested Previously Approved
05/31/1989 05/31/1989 05/31/1989
5 0 5
180 0 180
0 0 0

A STATE OR LOCAL HIGHWAY AGENCY IS TO FURNISH TO THE FEDERAL HIGHWAY ADMINISTRATION A STATEMENT ESTABLISHING ITS AUTHORITY TO PAY FOR UTILITY ADJUSTMENTS ON FEDERAL-AID PROJECTS.

None
None


No

1
IC Title Form No. Form Name
SUBMISSION OF ELIGIBILITY STATEMENT FOR UTILITY ADJUSTMENTS

  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 5 5 0 0 0 0
Annual Time Burden (Hours) 180 180 0 0 0 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.
04/06/1989


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