Information Collection

Regional Resource Center Monthly Report Form

IC 25128 under ICR 201209-2105-001 · OMB 2105-0554.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2105-0554 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DOT F 4500 Regional Resource Center Monthly Report Form	Form
DOT F 4500 The Regional Center Intake Form DOT F 4500.pdf	Form

IC Title:

Regional Resource Center Monthly Report Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation: 49 CFR 23 49 CFR 26

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DOT F 4500	The Regional Center Intake Form	DOT F 4500.pdf		Yes	No	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 100

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-1,200	1,200
Annual IC Time Burden (Hours)	-600	600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.