Information Collection

Enrollment Statement of Compliance and Checklist

IC 250876 under ICR 202112-2133-001 · OMB 2133-0553.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2133-0553 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form MA-1085 Enrollment Statement of Compliance and Checklist	Form and Instruction
MA-1085 EMBARC Statement of Compliance 20211221 EMBARC Statement of Compliance.docx	Form and Instruction

IC Title:

Enrollment Statement of Compliance and Checklist

Agency IC Tracking Number:

2133-NEW

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

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	MA-1085	EMBARC Statement of Compliance	20211221 EMBARC Statement of Compliance.docx		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Water Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 35

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	35	35
Annual IC Time Burden (Hours)	70	70
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.