OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

The Regional Center Intake Form

IC 203950 under ICR 202304-2105-002 · OMB 2105-0554.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

The Regional Center Intake Form
 
No Modified
 
Required to Obtain or Retain Benefits
 
49 CFR parts 23 and 26  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction DOT F 4500 The Regional Center Intake Form DOT_F_4500_SBTRC_Field_Office_Intake_Form.doc Yes Yes Fillable Fileable

Transportation Ground Transportation

 

100 100
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 100 0 0 0 100 0
Annual IC Time Burden (Hours) 150 0 -450 0 600 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.