Information Collection

Shippers and Carriers - Consent Form

IC 212109 under ICR 201509-2137-001 · OMB 2137-0034.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2137-0034 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
;Shippers and Carriers - Consent Form.docx	Other-Shipper and Carrier Consent Fo

IC Title:

Shippers and Carriers - Consent Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation: 49 CFR 172.200 49 CFR 172.201 49 CFR 172.202

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
Other-Shipper and Carrier Consent Form			;Shippers and Carriers - Consent Form.docx		Yes	Yes	Fillable Printable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 55

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-55	55
Annual IC Time Burden (Hours)	-5	5
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.