Information Collection

Report of DBE Awards and Commitments

IC 25080 under ICR 201209-2105-004 · OMB 2105-0510.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2105-0510 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DOT Form 4630 Report of DBE Awards and Commitments	Form
DOT Form 4630 Uniform Report of DBE Awards/Commitments and Payments DBE uniform form.pdf	Form
Appendix G Personal Net Worth Statement Appendix G.pdf	Form and Instruction
Appendix F UNIFORM CERTIFICATION APPLICATION Appendix F.pdf	Form and Instruction
Appendix B UNIFORM REPORT OF DBE COMMITMENTS Appendix B.pdf	Form and Instruction
Final DBE Rept Frm Instructions.pdf DBE Form Instructions	IC Document

IC Title:

Report of DBE Awards and Commitments

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 49 CFR Part 26 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DOT Form 4630	Uniform Report of DBE Awards/Commitments and Payments	DBE uniform form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix G	Personal Net Worth Statement	Appendix G.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix F	UNIFORM CERTIFICATION APPLICATION	Appendix F.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix B	UNIFORM REPORT OF DBE COMMITMENTS	Appendix B.pdf	Yes	Yes	Printable Only

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,250

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 85 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,800	0	1,800
Annual IC Time Burden (Hours)	309,000	300,000	9,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
DBE Form Instructions	Final DBE Rept Frm Instructions.pdf	11/16/2010

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