Information Collection Request
Counseling Information Form; Regional Center Intake Form and Quarterly (formerly Monthly) Report of Operations Form.
ICR 202304-2105-002 · OMB 2105-0554 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form DOT F 4500 The Regional Center Intake Form |
Form and Instruction | Modified | Repair queued |
 OSDBU_2105-0554_Supporting Statement_Renewal_2023.docx |
Supporting Statement A | Uploaded 2023-05-30 | Repair queued |
 Published 30-day FRN Notice_.pdf |
Supplementary Document | Uploaded 2023-05-26 | Repair queued |
| 2105-0554 60 day FRN.pdf |
Supplementary Document | Uploaded 2023-04-12 | Repair queued |
| MRC _ Statute.pdf |
Supplementary Document | Uploaded 2008-10-06 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 203950 |  The Regional Center Intake Form |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | DOT/OST |
| OMB Control No | 2105-0554 |
| Type of Information Collection | Reinstatement without change of a previously approved collection |
| Previous ICR Reference No | 201907-2105-002 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |