Information Collection

IC-4.2 Hiring carrier provides prior employer safety history to applicant

IC 238308 under ICR 202012-2126-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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-4.2 Hiring carrier provides prior employer safety history to applicant

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 49 CFR CFR 391.23(i)(2) (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

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 320,000

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
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	320,000	2,000	318,000
Annual IC Time Burden (Hours)	16,000	100	15,900
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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