Information Collection

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

IC 250989 under ICR 202112-2126-004 · OMB 2126-0075.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.