Counseling Information Form; Regional Center Intake Form and Quarterly (formerly Monthlly) Report of Operations Form.

Forms and Documents

Document	Type	Status	Availability
Form DOT F 4500 Regional Resource Center Monthly Report Form	Form	Removed	Available
Form DOT F 4502 The Regional Resource Center Quarterly Report Form	Form and Instruction	New	Repair queued
Form DOT F 4500 The Regional Center Intake Form	Form and Instruction	New	Repair queued
Form DOT F 4502 Regional Resource Center Monthly Report Form	Form	Removed	Repair queued
Supporting_Statement_for_2105-0554_-_OSDBU[2].doc	Supporting Statement A	Uploaded 2013-02-11	Repair queued
2105_0554_Art_60_Day_2012-2044.pdf	Supplementary Document	Uploaded 2012-09-05	Available
2105_0554_Art_30_Day_2012-13199.pdf	Supplementary Document	Uploaded 2012-09-05	Available
MRC _ Statute.pdf	Supplementary Document	Uploaded 2008-10-06	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
25128	Regional Resource Center Monthly Report Form	Form	Removed
203951	The Regional Resource Center Quarterly Report Form	Form and Instruction	New
203950	The Regional Center Intake Form	Form and Instruction	New
186824	Regional Resource Center Monthly Report Form	Form	Removed

ICR Details

OMB Control No: 2105-0554	ICR Reference No: 201209-2105-001
Status: Historical Active	Previous ICR Reference No: 200810-2105-002
Agency/Subagency: DOT/OST	Agency Tracking No: 2105-0554
Title: Counseling Information Form; Regional Center Intake Form and Quarterly (formerly Monthlly) 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 with change	Conclusion Date: 02/11/2013
	Date Received in OIRA: 09/05/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2016	36 Months From Approved
Responses	800	0	0
Time Burden (Hours)	1,800	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The collection involves the use of the Regional Center Intake Form (DOT F 4500) and use of Regional Resource Center Quarterly (formerly Monthly) Report Form (DOT F 4502). SBTRC's Regional Field Offices will collect information on small businesses and types of services they seek from the Regional Field Offices.

---

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:
	77 FR 4862	01/31/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 32169	05/31/2012
Did the Agency receive public comments on this ICR? No

---

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

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

---

ICR Summary 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	800	0	0	800	-2,400	2,400
Annual Time Burden (Hours)	1,800	0	0	1,800	-1,800	1,800
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: The Regional Resource Center Quarterly Report Form (DOT F 4502) was changed from an earlier form called the Monthly Report Form (DOT F 4502). The reason for the change to the Quarterly Report Form was to have a more comprehensive reporting of services provided to small businesses over a longer period of time. It also saves time for the Regional Field Offices to compile reports four (4) times a year, versus 12 times a year.

---

Annual Cost to Federal Government: $7,758

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 09/05/2012

---