Information Collection

G - Personal Net Worth

IC 254730 under ICR 202403-2105-004 · OMB 2105-0586.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2105-0586 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
G - Personal Net Worth	Form and Instruction
Personal Net Worth G - Personal Net Worth	Form and Instruction
Personal Net Worth Personal Net Worth Statement.docx	Form and Instruction
Personal Net Worth Personal Net Worth Statement.docx	Form and Instruction

IC Title:

G - Personal Net Worth

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 49 CFR 26.68(b)

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	n/a	Personal Net Worth	Personal Net Worth Statement.docx		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,375

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,375	4,375
Annual IC Time Burden (Hours)	35,000	35,000
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.