Information Collection

IC-4.3 Driver prepares and submits rebuttal to previous employer

IC 238309 under ICR 201910-2126-001 · OMB 2126-0004.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2126-0004 can be found here:

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IC Title:

IC-4.3 Driver prepares and submits rebuttal to previous employer

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 49 CFR CFR 391.23(j)(3) (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

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Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 32,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	32,000	32,000
Annual IC Time Burden (Hours)	16,000	16,000
Annual IC Cost Burden (Dollars)	0	0

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