Information Collection

WB-AWARD-Individual with Legal Representative

IC 262370 under ICR 202309-2127-001 · OMB 2127-0767.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2127-0767 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NHTSA Form 1686 WB-AWARD-Individual with Legal Representative	Form and Instruction
NHTSA Form 1686 FORM WB-AWARD WHISTLEBLOWER AWARD APPLICATION WB-AWARD Form (Appendix C to Part 513).docx	Form and Instruction
NHTSA Form 1686 FORM WB-AWARD WHISTLEBLOWER AWARD APPLICATION WB-AWARD Form (Appendix C to Part 513).docx	Form and Instruction

IC Title:

WB-AWARD-Individual with Legal Representative

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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	NHTSA Form 1686	FORM WB-AWARD WHISTLEBLOWER AWARD APPLICATION	WB-AWARD Form (Appendix C to Part 513).docx		Yes	Yes	Fillable Fileable Signable

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: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2	2
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	10,640	10,640

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.