23 CFR Parts Uniform Safety Program Cost Summary Form for Highway Safety Plan

ICR 200503-2127-001

OMB: 2127-0003

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
2127-0003 200503-2127-001
Historical Active 200201-2127-002
DOT/NHTSA
23 CFR Parts Uniform Safety Program Cost Summary Form for Highway Safety Plan
Extension without change of a currently approved collection   No
Regular
Approved without change 04/20/2005
Retrieve Notice of Action (NOA) 03/18/2005
  Inventory as of this Action Requested Previously Approved
04/30/2008 04/30/2008 04/30/2005
1,140 0 1,140
570 0 570
0 0 0

In order to account for funds expended under the priority areas and other program areas, States are required to submit a Program Cost Summary data to identify proposed funded activities previously planned.

None
None


No

1
IC Title Form No. Form Name
23 CFR Parts Uniform Safety Program Cost Summary Form for Highway Safety Plan HS-FORM-217

  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 1,140 1,140 0 0 0 0
Annual Time Burden (Hours) 570 570 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.
03/18/2005


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