IC-3: Experienced Driver Information Form & Informed Consent Form

Safe Driver Apprenticeship Pilot Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2126-0075 can be found here:

Documents and Forms

Document Name Document Type
Form Form 3 IC-3: Experienced Driver Information Form & Informed Consent Form Form and Instruction
Form 3 Experienced Driver Application Attachment G_SafeDriverAPP_Experienced Driver_Information Form.docx Form and Instruction
Form 3 Experienced Driver Application Attachment G_SafeDriverAPP_Experienced Driver_Information Form.docx Form and Instruction

Information Collection (IC) Details

IC Title:	IC-3: Experienced Driver Information Form & Informed Consent 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: 29 CFR 29

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form 3	Experienced Driver Application	Attachment G_SafeDriverAPP_Experienced Driver_Information Form.docx		Yes	Yes	Fillable Printable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,730	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	2,730	2,730
Annual IC Time Burden (Hours)	910	910
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.