Information Collection

Enrollment Statement of Compliance and Checklist

IC 250876 under ICR 202206-2133-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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
MA-1085 EMBARC _Statement_of_Compliance 20211221 EMBARC Statement of Compliance.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Enrollment Statement of Compliance and Checklist	Agency IC Tracking Number:	2133-NEW

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

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	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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	35	0	35
Annual IC Time Burden (Hours)	70	0	70
Annual IC Cost Burden (Dollars)	2,054	2,054	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.