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⚠️ Notice: This information collection may be referencing outdated material.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 Uniform Report of DBE Awards/Commitments and Payments Report of DBE Awards and Commitments	Form
Form Appendix G Personal Net Worth Statement Report of DBE Awards and Commitments	Form and Instruction
Form Appendix F UNIFORM CERTIFICATION APPLICATION Report of DBE Awards and Commitments	Form and Instruction
Form Appendix B UNIFORM REPORT OF DBE COMMITMENTS Report of DBE Awards and Commitments	Form and Instruction
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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DOT Form 4630	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix G	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix F	Yes	Yes	Fillable Fileable
Form and Instruction	Appendix B	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		11/16/2010

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

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