IC-4: Performance Benchmark Certifications

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⚠️ Notice: This information collection may be referencing outdated material.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 4 IC-4: Performance Benchmark Certifications Form and Instruction
Form 4 Probation Period 1 Benchmark Certification Attachment I_SafeDriverAPP_Probation Period 1_BenchmarkCert.docx Form and Instruction
Form 4 Probation Period 1 Benchmark Certification Attachment I_SafeDriverAPP_Probation Period 1_BenchmarkCert.docx Form and Instruction
Form 5 Probation Period 2 Benchmark Certification Attachment J_SafeDriverAPP_Probation Period 2_BenchmarkCert.docx Form and Instruction
Form 5 Probation Period 2 Benchmark Certification Attachment J_SafeDriverAPP_Probation Period 2_BenchmarkCert.docx Form and Instruction

Information Collection (IC) Details

IC Title:	IC-4: Performance Benchmark Certifications	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form 4	Probation Period 1 Benchmark Certification	Attachment I_SafeDriverAPP_Probation Period 1_BenchmarkCert.docx		Yes	Yes	Fillable Printable
Form and Instruction	Form 5	Probation Period 2 Benchmark Certification	Attachment J_SafeDriverAPP_Probation Period 2_BenchmarkCert.docx		Yes	Yes	Fillable Printable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,200	-17,800	21,000
Annual IC Time Burden (Hours)	800	-4,450	5,250
Annual IC Cost Burden (Dollars)	0	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.