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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DOT F 4500 The Regional Center Intake Form	Form	Modified	Available
Form DOT F 4502 The Regional Resource Center Monthly Report Form	Form	New	Available
JUSTIFICATION10308 (3).doc	Supporting Statement A	Uploaded 2008-10-06	Available
MRC _ Statute.pdf	Supplementary Document	Uploaded 2008-10-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
25128	Regional Resource Center Monthly Report Form	Form	Modified	The Regional Center Intake Form
186824	Regional Resource Center Monthly Report Form	Form	New	The Regional Resource Center Monthly Report Form

ICR Details

OMB Control No: 2105-0554	ICR Reference No: 200810-2105-002
Status: Historical Active	Previous ICR Reference No: 200504-2105-002
Agency/Subagency: DOT/OST	Agency Tracking No: 2105-0554
Title: Counseling Information Form; Regional Center Intake Form and Monthly Report of Operations Form.
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/21/2009
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/16/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2012	36 Months From Approved
Responses	2,400	0	0
Time Burden (Hours)	1,800	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The Office of Small and Disadvantaged Business Utilization (OSDBU)request OMB's approval to reinstate/renew information forms, associated with OSDBU. The collection involves the use of the Regional Center Intake Form (DOT F 4500) and use of Regional Resource Center Monthly Report Form (DOT F 4502).

---

Authorizing Statute(s): PL: Pub.L. 95 - 507 8,15, and 31 Name of Law: Small Business Act (SBA)
   US Code: 49 USC Section 332 Name of Law: Minority Resource Center (MRC)
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 36368	06/26/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 55892	09/26/2008
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Regional Resource Center Monthly Report Form	DOT F 4500	The Regional Center Intake Form
Regional Resource Center Monthly Report Form	DOT F 4502	The Regional Resource Center Monthly Report Form

---

ICR Summary of Burden

table that charts list of burden

	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	2,400	0	0	0	-7,950	10,350
Annual Time Burden (Hours)	1,800	0	0	0	-2,511	4,311
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This reinstatement resulted in a program change decrease due to elimination of the Counseling Information Form and combined categories with the Regional Resource Center Monthly Report Form (DOT F 4502). This will facilitate the collection of data by using a computerized process to make the completion more efficient and to facilitate the storage and retrieval of the data when required.

---

Annual Cost to Federal Government: $41,094

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 10/16/2008

---