Counseling Information Form; Regional Center Intake Form and Monthly Report of Operations Form.

ICR 200504-2105-002

OMB: 2105-0554

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
2105-0554 200504-2105-002
Historical Active
DOT/OST
Counseling Information Form; Regional Center Intake Form and Monthly Report of Operations Form.
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 08/25/2005
Retrieve Notice of Action (NOA) 04/07/2005
  Inventory as of this Action Requested Previously Approved
08/31/2008 08/31/2008
10,350 0 0
4,311 0 0
0 0 0

The Regional Minority Resource Centers (MRCs) will collect information on Disadvantaged Business Enterprises. Such data includes the DBE's company name, type of certification, number of employees, etc.

None
None


No

1
IC Title Form No. Form Name
Counseling Information Form; Regional Center Intake Form and Monthly Report of Operations Form. DOT-4640.1

  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 10,350 0 0 10,350 0 0
Annual Time Burden (Hours) 4,311 0 0 4,311 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
04/07/2005


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