Information Collection

IC-10: Application for Authority to Self-Insure Under 49 U.S.C. 13906

IC 188066 under ICR 202208-2126-003 · OMB 2126-0017.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2126-0017 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form BMC-40 IC-10: Application for Authority to Self-Insure Under 49 U.S.C. 13906	Form and Instruction
BMC-40 Application for Authority to Self-Insure Under 49 U.S.C. BMC-40 7-20-2022 508.pdf www.fmcsa.dot.gov/registration/form-bmc-40-application-authority-self-insure-under-49-usc-13906	Form and Instruction
BMC-40 Application for Authority to Self-Insure Under 49 U.S.C. BMC-40 7-20-2022 508.pdf www.fmcsa.dot.gov/registration/form-bmc-40-application-authority-self-insure-under-49-usc-13906	Form and Instruction

IC Title:

IC-10: Application for Authority to Self-Insure Under 49 U.S.C. 13906

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 49 CFR 387

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	BMC-40	Application for Authority to Self-Insure Under 49 U.S.C. 13906	BMC-40 7-20-2022 508.pdf	https://www.fmcsa.dot.gov/registration/form-bmc-40-application-authority-self-insure-under-49-usc-13906	Yes	No	Fillable Printable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2

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	Previously Approved
Annual Number of Responses for this IC	2	2
Annual IC Time Burden (Hours)	80	80
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.