Information Collection

Uniform Certification Application Form

IC 213904 under ICR 201410-2105-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Appendix F Uniform Certification Application Form	Form and Instruction
Appendix F Certification Application For Internal Coordination Certification Application with PRA statement.pdf	Form and Instruction

IC Title:

Uniform Certification Application Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Appendix F	Certification Application For Internal Coordination	Certification Application with PRA statement.pdf		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9,500

Number of Respondents for Small Entity: 9,500

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	9,500	9,500
Annual IC Time Burden (Hours)	76,000	76,000
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.