Counseling Information Form; Regional Center Intake Form and Quarterly (formerly Monthly) Report of Operations Form.

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DOT F 4502 The Regional Resource Center Quarterly Report Form	Form and Instruction	Removed	Available
Form DOT F 4500 The Regional Center Intake Form	Form and Instruction	Modified	Available
SS_2015-0554_FIELD_OFFICES.DOT_F4500_Feb_2016_HB.doc	Supporting Statement A	Uploaded 2016-04-13	Available
2105_0554_30_Day_Notice_Feb_8_2016.pdf	Supplementary Document	Uploaded 2016-02-29	Available
60_Day_Notice_2105_0554_Regional_Field_Offices_Intake_Form.pdf	Supplementary Document	Uploaded 2016-02-29	Available
MRC _ Statute.pdf	Supplementary Document	Uploaded 2008-10-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
203951	The Regional Resource Center Quarterly Report Form	Form and Instruction	Removed
203950	The Regional Center Intake Form	Form and Instruction	Modified

ICR Details

OMB Control No: 2105-0554	ICR Reference No: 201602-2105-004
Status: Historical Active	Previous ICR Reference No: 201209-2105-001
Agency/Subagency: DOT/OST	Agency Tracking No: 2105-0554
Title: Counseling Information Form; Regional Center Intake Form and Quarterly (formerly Monthly) Report of Operations Form.
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/01/2016
	Date Received in OIRA: 04/20/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2019	36 Months From Approved
Responses	100	0	0
Time Burden (Hours)	600	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Office of Small and Disadvantaged Business Utilization administers the provisions of Title 49, of the United States Code, Section 332, the Minority Resource Center (MRC) which includes the duties of advocacy, outreach, and financial services on behalf of small and disadvantaged businesses and those certified under CFR 49 parts 23 and or 26 as Disadvantaged Business Enterprises (DBE).Show citation box The collection involves the use of the Regional Center Intake Form (DOT F 4500) and use of Regional Resource Center Quarterly (formerly Monthly) Report Form (DOT F 4502). SBTRC's Regional Field Offices will collect information on small businesses and types of services they seek from the Regional Field Offices. People filling out the Regional Field Offices Intake Form (DOT F 4500) are paid with grant money from the Federal Government, so the participant are not spending any money of their on preparing and submitting reports.

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Authorizing Statute(s): PL: Pub.L. 95 - 507 8,15, and 31 Name of Law: Small Business Act (SBA)
   US Code: 49 USC Section 332 Name of Law: Minority Resource Center (MRC)
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 70078	11/12/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 6584	02/08/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
The Regional Center Intake Form	DOT F 4500	The Regional Center Intake Form
The Regional Resource Center Quarterly Report Form	DOT F 4502	DOT SBTRC Field Office Quarterly Report Form

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	100	0	0	-300	-400	800
Annual Time Burden (Hours)	600	0	0	0	-1,200	1,800
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Participants are no longer required to submit monthly reports, therefore DOT F 4502 is not used anymore. We now require only one form which is "SBTRC Regional Field Offices Intake Form (DOT F 4500). Switching from monthly information collection to quarterly is the reason behind drop in burden hours.

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Annual Cost to Federal Government: $7,758

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/20/2016

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